Hernia最新文献

Purpose: To determine whether differences in operative approach and outcomes after ventral hernia repair (VHR) are primarily associated with case acuity and hernia complexity rather than surgeon practice grouping.

Methods: Adult VHRs recorded in the Abdominal Core Health Quality Collaborative (ACHQC)registry from 2013-2023 were analyzed. Cases were grouped by surgeon practice category (General Surgery [GS], Minimally Invasive Surgery [MIS], and Acute Care/Trauma Surgery [ACS]). Patient characteristics included demographics, ASA class, case urgency, operative approach, mesh width, and operative duration. Outcomes included recurrence at 30 days, 6 months, and 1 year (among patients with available follow-up) and health-related quality of life measured by HerQLes, with moderate-to-major improvement defined as a ≥20-point increase from baseline among patients with paired assessments.

Results: A total of 73,241 VHRs were analyzed (GS 56.2%, MIS 28.1%, ACS 15.6%). Operative approach distribution was similar across groups (open 63.8%, robotic 26.0%,laparoscopic 10.2%; p>0.05). ACS cases more frequently involved very large meshes (≥30 cm) and prolonged operative duration (>240 minutes), reflecting higher case complexity (both p<0.05). Early quality-of-life improvement at 30 days was most pronounced among ACS patients, whereas GS patients demonstrated the highest proportion of sustained moderate-to-major improvement at 6 months. Recurrence was uncommon at 30 days across all groups and increased with longer follow-up, with the highest 1-year recurrence observed among ACS patients.

Conclusions: In this large contemporary registry, operative approach selection was similar across surgeon practice groups. Differences in outcomes were most strongly associated with case urgency and hernia complexity rather than surgeon classification. Early quality-of-life gains were greatest in higher-acuity cases, while more durable improvements and lower long-term recurrence were observed in elective repair contexts. These findings underscore the dominant role of patient and case factors in determining VHR outcomes.

Background: Abdominal wall function (AWF) has emerged as a pivotal outcome in patients with diastasis recti (DR) and midline ventral/incisional hernias, yet methods and timing of assessment remain heterogenous and non-standardized. This systematic review aimed to synthesize current evidence on how AWF is evaluated in the setting of DR and ventral/incisional hernia, and to appraise the clinical value of different assessment strategies.

Methods: This systematic review was reported according to PRISMA guidelines, with a comprehensive search in MEDLINE, Scopus, Embase, and CENTRAL up to August 31, 2025 (PROSPERO: CRD420251148381). Studies assessing AWF pre and post-surgery in patients with DR and/or ventral/incisional hernia using objective measures (e.g., dynamometry, standardized physical tests) and/or patient-reported outcome measures (PROMs) were included. Risk of bias was assessed using RoB-2 for randomized trials and MINORS for observational studies.

Results: Nine studies (2 randomized trials, 7 prospective cohorts; n = 688) evaluated abdominal wall function using trunk dynamometry, standardized clinical tests, and PROMs. Preoperatively, abdominal wall function was consistently impaired. Surgical reconstruction restoring the linea alba led to marked improvements: trunk strength improved on dynamometry, clinical tests normalized, and PROMs showed meaningful gains in quality of life and disability. In postpartum diastasis recti, benefits-including continence-persisted at 3 years. No meta-analysis was conducted, and all findings represent a narrative synthesis.

Conclusion: In patients with diastasis recti or midline ventral/incisional hernias, most studies suggest that restoration of the linea alba is associated with measurable improvements in abdominal wall function and patient-reported outcomes. Wide adoption of standardized core outcome sets-integrating pragmatic objective tests with disease-specific PROMs-and longer multicenter follow-up are essential to inform surgical decision-making and future guidelines.

Purpose: Incisional hernia (IH) is a common complication of abdominal surgery, and the optimal suture technique for midline fascial closure remains controversial. This study compared continuous barbed sutures with interrupted non-barbed sutures in patients who underwent minimally invasive colorectal cancer surgery.

Methods: We retrospectively evaluated 299 patients who underwent laparoscopic or robotic radical colorectal resection between 2020 and 2023. Of these, 228 who underwent a small midline umbilical incision were included. Fascial closure was performed using either continuous barbed absorbable sutures (n = 60) or interrupted non-barbed absorbable sutures (n = 162). Propensity score matching (PSM) was performed at a 1:1 ratio, yielding 51 matched pairs for comparison. Primary outcome was IH incidence as confirmed by computed tomography or physical examination. Secondary outcomes focused on infectious complications as well as postoperative morbidity, mortality, and hospital stay.

Results: After PSM, the incidence of IH was significantly lower in the continuous barbed group than that in the interrupted non-barbed group (7.8% vs. 33.3%, P = 0.001). In non-obese patients (Body mass index < 25), barbed closure reduced the IH incidence (2.7% vs. 23.5%, P = 0.006). In obese patients, the difference was not statistically significant (21.4% vs. 52.9%, P = 0.07), likely reflecting limited power. Although ileus was more frequent in the interrupted non-barbed group (7.8% vs. 0%, P = 0.02), infectious complications were comparable between groups. Multivariable analysis identified interrupted non-barbed sutures and obesity as independent risk factors for IH.

Conclusions: Continuous barbed fascial closure was associated with a significantly lower IH incidence after minimally invasive colorectal cancer surgery without increasing infectious complications. These findings support the effectiveness of a barbed-continuous closure strategy for midline extraction incisions.

Background: Single-incision laparoscopic totally extraperitoneal inguinal hernia repair (SIL-TEP) has gained attention for its potential to minimize surgical trauma and improve cosmesis. However, its comparative efficacy and safety versus conventional multi-port laparoscopic totally extraperitoneal repair (MTL-TEP) remain contentious.

Objective: This meta-analysis aimed to systematically evaluate the feasibility and safety of SIL-TEP compared to MTL-TEP.

Methods: A systematic literature search was conducted in databases including PubMed, Embase, and the Cochrane Library from January 2005 to June 2025. Data on postoperative outcomes were extracted and pooled for meta-analysis. Statistical analyses were performed using RevMan 5.4, calculating mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI).

Results: Analysis of 23 studies (7 RCTs, 16 non-RCTs; 2894 patients) showed SIL-TEP had a longer unilateral operative time (MD = 4.39 min, 95% CI: 0.88-7.89, P = 0.01), though this was not significant in study design subgroup analysis. SIL-TEP offered superior early outcomes, including lower pain scores on postoperative day 7 (MD = -0.57, 95% CI: -1.09 to -0.05, P = 0.03) and higher cosmetic satisfaction (MD = 0.77, 95% CI: 0.27-1.28, P = 0.002). The techniques were comparable in bilateral operative time, overall complications (OR = 0.92, P = 0.48), hospital stay (MD = -0.02, P = 0.50), and recurrence rates (OR = 0.81, P = 0.65).

Conclusion: This meta-analysis suggests that SIL-TEP is a safe and feasible alternative to MTL-TEP. The pooled results indicate potential benefits of SIL-TEP in reducing early postoperative pain and achieving better cosmetic outcomes, although these advantages were not sustained in the RCT subgroup analysis. Critically, both techniques demonstrated comparable safety profiles, with no significant differences in complication rates, hospital stay, and short-to-midterm recurrence risk. SIL-TEP represents a viable surgical option that can be individualized for patients, particularly those who place a high value on minimal scarring.

Background: Stoma-site incisional hernias (SSIHs) are a common complication following ileostomy or colostomy reversal. Prophylactic mesh placement during stoma closure may reduce this risk, but adoption is limited by concerns regarding mesh safety and uncertainty regarding long-term benefit.

Methods: We conducted a systematic review and meta-analysis of randomised controlled trials comparing prophylactic mesh with standard fascial closure during elective stoma reversal. The primary outcome was SSIH within 12 months. Secondary outcomes included surgical-site infection (SSI), mesh-related complications, anastomotic leak, operative time, and patient-reported outcomes. Risk of bias was assessed using ROB 2.0, and certainty of evidence was evaluated using GRADE.

Results: Three RCTs comprising 957 patients (mesh: n = 477; control: n = 480) were included. Prophylactic mesh significantly reduced SSIH at 12 months (risk ratio 0.25, 95% CI 0.08-0.76), with an absolute risk reduction of 13.6%. SSI (OR 1.21, 95% CI 0.84-1.74) and anastomotic leak (OR 1.08, 95% CI 0.50-2.33) did not differ significantly between groups. Operative time was longer in the mesh group (mean difference + 25.25 min, 95% CI 15.83-34.68). Mesh-related complications were rare, and no explantations occurred. Two trials reported improved hernia-specific quality of life with mesh.

Conclusion: Prophylactic mesh during elective stoma closure significantly reduces SSIH without increasing early complications. While operative time is modestly increased, the clinical benefit and safety profile support routine consideration of mesh, particularly in high-risk patients. Longer-term follow-up and cost-effectiveness data are needed to guide broader implementation.

Purpose: This study aimed to compare the rates of fascial dehiscence after fascial closure using the combined small-and-large technique versus the small-bite technique following emergency laparotomy.

Methods: A retrospective, single-center, observational study was conducted. All patients who underwent emergency midline laparotomy at the University Hospital Frankfurt in from 2022 till 2024 with either small-bite technique were included or combined small-and-large technique, which involves periodic internal reinforcement sutures. Propensity score matching was performed based on preoperative predictors of fascial dehiscence. The rate of fascial dehiscence was compared between the matched groups.

Results: A total of 294 patients were included. The combined small-and-large technique was used for fascial closure in 37 cases (12.6%), while the small-bite technique was used in 257 cases (87.5%). In descriptive statistics, fascial dehiscence was observed in 31 cases (10.5%); two cases (5.4%) in the group with combined small-and-large technique and 29 cases (11.3%) in the group with small-bite technique. After perfoming propensity score matching 29 cases were matched in each group, with one case of fascial dehiscence in the combined small-and-large technique versus 5 cases the small-bite technique group. However, there was no statistically significant difference.

Conclusion: A lower rate of fascial dehiscence may be achieved using the combined small-and-large technique following emergency laparotomy compared to the small-bite technique.