Hernia最新文献

Background: Thoracoabdominal hernias (TH), encompassing abdominal wall hernias such as flank hernias and diaphragmatic hernias, are rare conditions with poorly defined epidemiology and no standardized surgical strategy. Repair is technically challenging because it requires reconstruction across distinct anatomical structures, including the diaphragm, ribs, and abdominal wall. Optimal repair methods remain controversial.

Case presentation: A 70-year-old man with a history of descending aortic aneurysm repair presented with a progressive left flank bulge. Computed tomography revealed a large flank hernia accompanied by diaphragmatic deformation, suggesting a concomitant diaphragmatic hernia. Surgical repair was performed via a previous thoracoabdominal incision. Intraoperatively, dehiscence of the diaphragm from the rib cage was identified. The diaphragmatic defect was primarily closed and reinforced by anchoring the diaphragm to the ribs using full-thickness sutures. Subsequently, the flank hernia was repaired using a modified extraperitoneal mesh repair with wide dissection and cranial fixation of the mesh to the ribs, followed by additional onlay mesh reinforcement. The postoperative course was uneventful, and no recurrence or chronic pain was observed during follow-up.

Conclusion: Combined reconstruction of the diaphragm and abdominal wall using rib-anchored diaphragmatic repair and extraperitoneal mesh placement may be an effective option for complex thoracoabdominal hernias. This approach enables secure fixation and broad mesh overlap while minimizing postoperative bulging. Further studies are needed to validate its safety, durability, and long-term outcomes.

Purposes: Seroma is a frequent complication after laparoscopic hernias repair. Many techniques have been proposed to mitigate this issue, yet no approach has been standardized. This study aimed to evaluate the effectiveness of transversalis fascia plication to reduce this.

Methods: This randomized controlled trial was conducted at University Hospital from Jule 2024 to October 2025 after approval by the research ethics committee (MS-142-2024), involving adult patients who underwent TAPP repair for direct inguinal hernia. Exclusion criteria were indirect/pantaloon or recurrent hernias, conversion to open surgery, and concurrent procedures. Patients were randomized into two groups by ratio1:1 using computer-generated random sequence with opaque sealed envelopes opened only intraoperative after confirmation of direct hernia: Group A: underwent plication of the fascia transversalis, while the other did not. The primary outcome was the incidence of postoperative seroma. Secondary outcomes included postoperative recovery parameters and the complications. Secondary outcomes included postoperative recovery parameters and the complications.Statistical analysis was performed using SPSS version 27.

Results: 146 patients met the inclusion criteria. Demographic characteristics, preoperative comorbidities and hernia size were similar across both groups. At day 30 follow-up, 9 patients (12.3%) in the control group developed clinically detectable seromas, whereas none were in the plication group (p =0.002). Additionally, the plication group demonstrated a significantly faster return to normal activity and better pain scores.

Conclusions: Plication of the transversalis fascia during TAPP may reduce the incidence of seroma formation, and improve postoperative outcomes. Before starting the study, the trial was registered and approved by institutional research ethics committee (MS-142-2024).online, retrospectively registered on the Pan African Clinical Trials Registry (PACTR202511671623081).

Background: The choice of suture material for laparoscopic high ligation of pediatric indirect inguinal hernia remains debated. While non-absorbable sutures are traditionally preferred to minimize recurrence, they pose potential long-term risks as permanent foreign bodies, including suture reaction and theoretical oncogenic concerns. Recent expert consensus suggests absorbable sutures may be a viable alternative, though comparative evidence, particularly for slow-absorbable variants, is limited.

Objective: This study aimed to compare the surgical outcomes, specifically recurrence rates and suture-related complications, between slow-absorbable (Polydioxanone, PDS) and non-absorbable (MERSILK) sutures in single-port laparoscopic indirect inguinal hernia repair in children.

Methods: A retrospective analysis was conducted on 1022 children with unilateral indirect inguinal hernia who underwent surgery at our center between October 2022 and October 2023. Patients were divided into two groups based on the suture material used: a slow-absorbable suture group (n = 663) and a non-absorbable suture group (n = 359). Patient demographics, operative details, and postoperative complications (recurrence and suture knot reaction) were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for recurrence.

Results: The recurrence rate was 2.0% (13/663) in the slow-absorbable suture group and 0.8% (3/359) in the non-absorbable suture group; this difference was not statistically significant (P = 0.197). Multivariate analysis confirmed that suture type was not an independent risk factor for recurrence [OR = 1.898, 95% CI: 0.475-7.583, P = 0.365]. In contrast, a statistically significant higher incidence of suture knot reaction was observed in the non-absorbable group (0.8% vs. 0%, P = 0.043). Patient age and the internal ring diameter of theprocessus vaginalis were identified as significant independent risk factors for recurrence (P < 0.001 and P = 0.001, respectively).

Conclusion: The use of slow-absorbable sutures (PDS) for laparoscopic indirect inguinal hernia repair in children does not significantly increase recurrence rates compared to non-absorbable sutures (MERSILK), while effectively eliminating the risk of suture knot reactions. Recurrence is primarily determined by patient age and internal ring diameter, not suture absorbability. Slow-absorbable sutures present a safe and effective alternative, alleviating long-term foreign body concerns without compromising surgical success.

Objectives: The introduction of ultrasound-guided nerve blocks has led to significant advancements in pediatric postoperative analgesia. In this context, the caudal block (C), a well-established and effective analgesic technique used for many years, has been increasingly complemented by the transversus abdominis plane (TAP) block, which is thought to have fewer side effects and potentially greater efficacy. The aim of our study was to compare these two methods in terms of postoperative analgesic effectiveness.

Materials and methods: This study was conducted as a prospective, randomized, controlled trial. A total of 56 children, aged 1 to 10 years, classified as ASA I and II, undergoing elective inguinal hernia repair, were included. The patients were randomly assigned into two groups. Group T (n = 28) received a TAP block with 0.5 mL/kg of 0.25% bupivacaine under ultrasound guidance, while Group C (n = 28) received a caudal block with the same concentration and volüme of bupivacaine. The primary outcome of the study was the duration of postoperative analgesia, while secondary outcomes included the need for rescue analgesics, complications, and the effects on hemodynamic parameters.

Results: During the postoperative period, adequate analgesia was achieved in both groups for up to the first 4 h. However, after the 6th hour, there was a significant increase in pain scores in the caudal block group. The need for rescue analgesics was lower in the TAP group, although there was no difference in the total amount of analgesics used at 12 h.

Conclusion: Both TAP block and caudal block are effective in providing postoperative analgesia for children undergoing inguinal hernia repair. The TAP block may be preferred due to its longer-lasting postoperative effect and lower need for rescue analgesics.

Introduction: In Germany, the proportion of outpatient surgeries was low during the study period (2014-2019) and low by international standards. Less than 20% of inguinal hernias are treated on an outpatient basis. Hybrid DRGs are intended to promote outpatient treatment, but their impact on the quality of care and referral criteria has not been sufficiently investigated empirically.

Methods: A retrospective analysis of routine data included 90,512 cases from 41 company health insurance funds, spanning 2014 to 2019. These were analysed descriptively in terms of care sector, age, and surgical procedure, as well as through two logistic regressions on reoperations and complications, including interaction effects.

Results: The proportion of outpatient surgeries is already below 40 % in adults and continues to decline with increasing age. The choice of procedure differs significantly between sectors. The regressions explain only 3.3 % and 4 % of the variance, respectively, meaning that the variables have only a minor impact on the success of the surgery. Inpatient surgeries are associated with fewer reoperations and more complications, although the absolute effect size is small. The surgical procedures have a significant influence. There are no relevant interaction effects between the choice of sector and the other variables.

Discussion: A sector-specific allocation based on the analysed parameters cannot be justified based on evidence. Since inpatient procedures do not show consistent superiority, there is no medical advantage over outpatient procedures. A cost-adjusted design of hybrid DRGs appears necessary to enable indication-appropriate procedure selection and to avoid potential misguided incentives that compromise the quality of care.