Hernia最新文献

Purpose: The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a "bottom-to-up" approach.

Methods: An observational prospective data-collected and quality of life study is performed in selected patients with less than 10 cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score.

Results: A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53 min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4 h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33 months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score.

Conclusion: Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients.

Purpose: Non-invasive reduction in patients with incarcerated obturator hernias is an emergency surgery alternative. There are two non-invasive reduction types: manual and ultrasonographic (ultrasound-guided and ultrasound-assisted reduction). However, the impact of ultrasound guidance on manual reduction has not been adequately evaluated. We aimed to compare non-invasive ultrasound reduction with manual reduction in patients with incarcerated obturator hernias.

Methods: We searched MEDLINE, Cochrane Central Library, Embase, Ichushi Web, ClinicalTrial.gov, and ICTRP for relevant studies. The primary outcomes were success and bowel resection rates. We performed a subgroup analysis between ultrasound-guided and ultrasound-assisted reductions. This study was registered in PROSPERO (CRD 42,024,498,295).

Results: We included six studies (112 patients, including 12 from our cohort). The success rate was 78% (69 of 88 cases) with ultrasonographic reduction and 33% (8 of 24 cases) with manual reduction. The success rate was higher with ultrasonographic than with manual reduction. Subgroup analysis revealed no significant difference between ultrasonography-assisted (76%) and ultrasonography-guided (80%) reductions (p = 0.60). Non-invasive reductions were predominantly successful within 72 h of onset, although durations extended up to 216 h in one case. Among the successful reduction cases, emergency surgery and bowel resection were necessary in two cases after 72 h from onset. Bowel resection was required in 48% (12 of 25), where the non-invasive reduction was unsuccessful within 72 h of confirmed onset.

Conclusions: Ultrasonographic reduction can be a primary treatment option for patients with obturator hernias within 72 h of onset by emergency physicians and surgeons on call. Future prospective studies are needed to evaluate ultrasonographic reduction's impact.

Purpose: Incisional hernia is a common postoperative complication; however, few transcriptomic studies have been conducted on it. In this study, we used second-generation high-throughput sequencing to explore the pathogenesis and potential therapeutic targets of incisional hernias.

Methods: Superficial fasciae were collected from 15 patients without hernia and 21 patients with an incisional hernia. High-throughput sequencing of the fascia was performed to generate an expression matrix. We analyzed the matrix to identify differentially expressed genes (DEGs) and performed gene ontology and enrichment analyses of these DEGs. Additionally, an external dataset was utilized to identify key DEGs.

Results: We identified 1,823 DEGs closely associated with extracellular matrix (ECM) imbalance, bacterial inflammatory response, and fibrillar collagen trimerization. TNNT3, CMAY5, ATP1B4, ASB5, CILP, SIX4, FBN1 and FNDC5 were identified as key DEGs at the intersection of the two expression matrices. Moreover, non-alcoholic fatty liver disease-related, TNF, and IL-17 signaling pathways were identified as key enrichment pathways.

Conclusions: We identified eight key DEGs and three pathways associated with incisional hernias. Our findings offer new insights into the pathogenesis of incisional hernias and highlight potential targets for their prevention and treatment.

Purpose: The Ventral Hernia Working Group (VHWG) proposed a ventral hernia grading guideline, primarily supported by expert opinion, recommending biologic mesh placement in high-risk patients. We investigated the relationship between this industry-sponsored guideline and discourse around ventral hernia repair (VHR).

Methods: Medline platform from Web of Science's database identified publications "pre-VHWG"(1999-01-01 to 2009-12-31), and "post-VHWG"(2010-01-01 to 2020-12-31) describing VHR and complications or recurrence of VHR with the following comorbidities: COPD, smoking, diabetes, immunosuppression, or obesity. Poisson regression analyzed keyword frequency over time using logarithmically transformed data.

Results: Of 1291 VHR publications identified pre-VHWG and 3041 publications identified post-VHWG, 172 (13.3%) and 642 (21.1%) publications respectively included prespecified keywords. The keyword groups "biologic"(IRR 3.39,95%CI1.34-11.4,p = 0.022) and "comorbid"(IRR 1.95, 95%CI1.09-3.74,p = 0.033) significantly increased with frequency after publication of the VHWG.

Conclusion: The VHWG publication likely contributed to a focus on comorbidities and biologic mesh in the ensuing literature within the field of VHR.

Purpose: There is limited research on the impact of an ilioinguinal-iliohypogastric nerve block on intraoperative opioid consumption when conducting groin hernia repair in adults. Thus, the aim was to evaluate ilioinguinal-iliohypogastric nerve block for groin hernia patients at Shouldice Hospital.

Methods: The study was a pilot retrospective chart review on patients who underwent a Shouldice Repair from November 2023 to December 2023. This study compared individuals receiving an ilioinguinal-iliohypogastric nerve block with local anesthesia and fentanyl analgesia to those who received local anesthesia and fentanyl analgesia, by manually matching 1:1 on 12 demographic and intraoperative characteristics. Comparison between groups was performed using chi-square/Fisher Exact test for categorical and t-test/Mann-Whitney test for numerical variables depending on data distribution. Multivariable regression analysis was used to examine predictors of intraoperative use of fentanyl.

Results: In this study 50 matched pairs of unilateral primary inguinal hernia patients were analyzed. The ilioinguinal-iliohypogastric nerve block patients had lower recorded intraoperative fentanyl (85mcg less than control, p < .001) and dimenhydrinate (13 mg less than control, p < .001) than the control group patients. No differences were found in postoperative day 0 to 3 for acetaminophen, non-steroidal anti-inflammatory drug, and opioid consumption between the patients who did receive an ilioinguinal-iliohypogastric nerve block prior to surgery and those that did not.

Conclusion: The administration of an ilioinguinal-iliohypogastric nerve block prior to primary inguinal hernia repair using a Shouldice Repair is associated with a significantly lower intraoperative fentanyl consumption compared to non-administration.

Purpose: The purpose of this narrative review is to evaluate the implementation of robotic surgery in hiatal hernia and crural repair, based on the existing literature and to compare this approach to other established techniques.

Methods: We performed a non- systematic literature search of PubMed and MEDLINE on February 25, 2024 for papers published to date focusing on the surgical repair of hiatal hernias using the robotic platform. After eliminating publications based on eligibility criteria, 13 studies were selected for analysis.

Results: Robotic surgery is increasingly utilized in hiatal hernia repair due to its enhanced ergonomics and superior visualization capabilities. Operative times vary, with some studies indicating longer durations for robotic surgery (e.g., Giovannetti et al. demonstrated median operative time of 196 min for robotic compared to 145 min for laparoscopic) while others report shorter times (e.g., Lang F et al. demonstrated 88 min for robotic versus 102 min for laparoscopic). Recurrence rates between robotic and laparoscopic repairs are comparable, with reported recurrence rates of 1.8% for robotic and 1.2% for laparoscopic approaches by Benedix et al. Robotic surgery offers potential advantages, including reduced intraoperative blood loss (e.g., Giovannetti et al. mentioned median blood loss of 20 ml for robotic versus 50 ml for laparoscopic). The length of hospital stay and postoperative complication rates also vary, with some studies suggesting shorter stays and fewer complications for robotic surgery as surgeons become more proficient. Soliman et al. reported a statistically significant reduction in complication rates with robotic surgery (6.3% versus 19.2%).

Conclusions: Robotic surgery presents promising results regarding the length of hospital stay, conversion rate to open surgery and postoperative complication rates when compared to laparoscopy based on the existing literature. Despite the lack of striking differences, robotic hiatal hernia repair is a valid and evolving approach.

Introduction: The debate continues as to whether laparoscopic total Nissen (LNF) versus partial posterior Toupet fundoplication (LTF) leads to better outcomes in the surgical treatment of axial hiatal hernia with gastroesophageal reflux disease. In the most recent meta-analysis including 13 RCTs with 1564 patients, no significant difference was found between the two procedures in terms of perioperative complications and recurrent reflux rates. Further comparative analyses are urgently needed.

Methods: This retrospective analysis of prospectively recorded data from the Herniamed Registry compared the perioperative and 1-year follow-up outcomes after total Nissen versus partial Toupet fundoplication. Propensity score matching was chosen as the statistical method. Matching was performed for n = 2290 pairs.

Results: No systematic discrepancy was found between the Nissen and Toupet fundoplication for any of the outcome parameters (intraoperative complications LNF 2.10% vs LTF 1.48%, general complications 2.27% vs 2.88%, postoperative complications 1.44% vs 1.18%, complication-related reoperation 1.00% vs 0.91%, recurrence on 1-year follow-up 6.55% vs 5.33%, pain on exertion on 1-year follow-up 12.49% vs 9.52%, pain at rest on 1-year follow-up 10.44 vs 9.52% and pain requiring treatment on 1-year follow-up 9.61% vs 8.17%). Also the postoperative dysphagia rate showed with 5.34% after LNF and with 4.64% after LTF no significant difference.

Conclusion: The findings presented here did not show any significant difference up to 1 year after Nissen or Toupet fundoplication. This is in concordance with the findings of the meta-analyses. However, the perioperative and 1-year follow-up outcomes demonstrate that both operation techniques should be carried out by experienced surgeons.

Purpose: The radiographic rectus width to hernia width ratio (RDR) has been shown to predict ability to close fascial defect without additional myofascial release in open Rives-Stoppa abdominal wall reconstruction (AWR), but it has not been studied in robotic AWR. We aimed to examine various CT measurements to determine their usability in predicting the need for transversus abdominis release (TAR) in robotic AWR.

Methods: We performed a single-center retrospective review of 137 patients with midline ventral hernias over a 5-year period who underwent elective robotic retrorectus AWR. We excluded patients with M1 or M5 hernias, lateral/flank hernias, and hybrid repairs. The CT measurements included hernia width (HW), hernia width/abdominal width ratio (HW/AW), and RDR. Univariate, multivariate and area under the curve (AUC) analyses were performed.

Results: 58/137 patients required TAR (32 unilateral, 26 bilateral). Patients undergoing TAR had a significantly higher average HW and HW/AW and lower RDR. Multivariate analysis revealed that prior hernia repair was independently associated with need for TAR (p = 0.03). ROC analysis and AUC values showed acceptable diagnostic ability of HW, HW/AW and RDR in predicting need for TAR. Cutoffs of RDR ≤ 2, HW/AW > 0.3, and HW > 10 cm yielded high specificity in determining need for any TAR (97.5% vs. 96.2% vs. 92.4%) or bilateral TAR (95.5% vs. 94.6% vs. 92.8%).

Conclusion: History of prior hernia repair was a risk factor for robotic TAR. CT measurements have some predictive value in determining need for TAR in robotic AWR. Further prospective analysis is needed in this patient population.