Hernia最新文献

Purpose: Persistent postoperative pain is a major challenge in inguinal hernia surgery. However, the impact of intraoperative nerve management on postoperative pain is poorly understood. The aim was to evaluate how management of the three inguinal nerves during anterior mesh repair of inguinal hernia affects the risk for persistent postoperative pain.

Methods: Cohort study based on data from the Swedish Hernia Register (SHR) concerning management of the three inguinal nerves. Adult patients with an open anterior mesh repair between 2012 and 2017 and who had responded to a patient-reported outcome measure (PROM) questionnaire one year after surgery were included in the study.

Results: Out of eligible patients, 34,115 (69%) responded to the PROM questionnaire. Of these, 25.9% reported pain that could not be ignored and 15.7% reported pain interfering with daily activities one year after surgery. Identifying and/or preserving any of the three groin nerves was not seen to have a significant impact on the risk for persistent groin pain in multivariable ordinal regression analysis adjusted for type of anaesthesia, gender, age and emergency surgery.

Conclusion: In a setting where the nerves are handled according to the surgeon's intraoperative judgement focusing on identifying and/or preserving the nerves, there was no association between intraoperative management of the three inguinal nerves and the risk for persistent postoperative pain one year after surgery. While careful tissue handling is crucial to the avoidance of postoperative pain, pragmatic nerve resection did not increase the risk for persistent pain one year after surgery.

Purpose: Chronic Abdominal Wall Pain (CAWP) covers a broad spectrum of abdominal wall-related disorders, with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) being the most prevalent. Treatment strategies in published literature are limited and often not clearly outlined. This scoping review aims to outline current available literature about the management of ACNES, focusing on trigger point injections (TPI), pulsed radiofrequency (PRF) and surgical neurectomy.

Methods: A systematic search in PubMed and EMBASE was performed until December 2024, in compliance with PRISMA guidelines. Articles concerning treatment for ACNES in adult patients were eligible. Data was collected on patient-reported outcomes using Numeric Rating Scale (NRS), Verbal Rating Scale (VRS) and EQ-5D-5 L scale. Success rate was determined as ≥ 50% NRS reduction and/or ≥ 2-point VRS reduction.

Results: A comprehensive search identified 18 records containing 3007 patients eligible for inclusion, including 7 randomized controlled trials (RCTs), 9 retrospective cohort studies and 2 retrospective case series. TPI has been considered as first step in the management of ACNES, offering both a diagnostic tool and a long-term success rate of 30%. PRF, as minimally invasive technique, tends to have a successful outcome in 20% with only a median temporary effect of 4 months. Surgical neurectomy provides long-term pain relief in 61%. Secondary surgery with anterior re-exploration or posterior neurectomy is long-term beneficial in 66% of refractory ACNES patients. The success rate for recurrent pain is significantly higher compared to residual pain after primary neurectomy.

Conclusion: TPI, PRF and neurectomy are the cornerstones of ACNES treatment, often used in a three-step treatment algorithm. With an accurate diagnosis of ACNES, surgical neurectomy provides the best long-term effect on pain reduction. Future studies should standardize outcome measures, directing for a standardized step-up treatment algorithm in collaboration with pain specialists.

Background: Incisional and non-incisional ventral hernias are common and important causes of symptoms, functional restriction, and complications, with significant potential to impact upon quality of life. The goals of hernia repair are to treat, prevent or improve these. However, outcomes of surgery remain relatively poor with significant gaps within the evidence base, which may be due to inconsistent use of outcome measures. The aim of this study was to appraise outcome reporting in the recent literature of randomized controlled trials (RCTs).

Objectives: This scoping review aimed to map and categorize the outcome measures reported in RCTs of incisional and non-incisional ventral hernia repair.

Eligibility criteria: All RCTs assessing any intervention related to incisional, primary, or recurrent ventral hernia repair between2015 and 2025 were included.

Source of evidence: A literature search was performed of the PubMed, EMBASE (1974 to present), and Cochrane Central Register of Controlled Trials databases in November March 2025.

Charting methods: Data was extracted independently by two reviewers. All outcomes reported by the included studies were identified and recorded.

Results: 118 RCTs were included. Their outcomes were mapped into five main broad categories. The commonest outcomes used were short-term operative complications (72.9%), hernia recurrence (59.3%), pain (57.6%), and quality of life (33.9%). Patient-reported outcomes were measured in 78 (66.1%) randomized controlled trials, of which 15 assessment tools were identified; 11 were generic, and 4were hernia-specific. There was considerable heterogeneity in how and when these endpoints were assessed and defined.

Conclusion: This scoping review found considerable differences in outcome reporting in contemporary RCTs of incisional and non-incisional ventral hernia. These have significant implications for translating evidence into practice, and its synthesis, and support the need for a core outcome set in this field. However, we identified areas such as abdominal wall function which are infrequently reported and require consideration.

Purpose: Retromuscular ventral hernia repair (RVHR) is a well-established and increasingly popular technique for mesh placement, offering favorable recurrence and complication rates. However, the role of mesh fixation in RVHR remains unclear, as some have questioned its effect on reducing recurrence and could potentially increase postoperative morbidity. We performed a systematic review and meta-analysis to compare outcomes of RVHR with and without mesh fixation.

Methodology: PubMed, EMBASE, and Cochrane Library were searched through July 2025. Eligible studies included adult patients undergoing open RVHR with or without fixation. Primary outcomes were hernia recurrence and postoperative pain; secondary outcomes included hematoma, seroma, surgical site infection (SSI), reoperation, operative time, length of stay (LOS), and quality of life. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects models were used, and heterogeneity was quantified using the I2 statistic.

Results: Six studies (15,106 patients; 3,994 without fixation) met inclusion criteria: two randomized controlled trials and four observational cohorts, including one registry study. Recurrence did not differ between fixation and non-fixation (OR 1.1, 95% CI 0.91-1.34; I2 = 0%). Fixation was associated with significantly worse quality-of-life scores (MD -12.71, 95% CI -16.48 to -8.93; p < 0.001; I2 = 0%) and higher hematoma risk (OR 5.18, 95% CI 1.18-22.68; p = 0.03; I2 = 0%). No significant differences were found for pain, SSI, seroma, reoperation, LOS, or operative time.

Conclusion: Our systematic review and meta-analysis identified no difference in recurrence, pain, SSI, or long-term outcomes between mesh fixation and non-fixation in RVHR. However, fixation was associated with significantly worse quality-of-life scores and a higher risk of hematoma. These findings suggest a selective rather than routine use of mesh fixation in RVHR.

Introduction: Parastomal hernias (PSHs) significantly impact the quality of life and pose risks including obstruction and stoma dysfunction. Minimally invasive approaches, particularly robotic surgery, are increasingly employed for elective PSH repairs, yet comparative outcomes remain insufficiently studied. This study evaluated short-term outcomes comparing robotic and open PSH repairs.

Methods: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients undergoing elective open, laparoscopic, or robotic PSH repairs were identified. Propensity score matching was used to balance baseline characteristics, and multivariate logistic regression identified independent predictors of complications.

Results: Of 1,322 patients, 734 (55.5%) underwent open repair, 408 (30.9%) robotic, and 180 (13.6%) laparoscopic. After matching 808 patients (404 robotic, 404 open), robotic repair significantly reduced overall complications (50 patients, 12.4% vs. 101 patients, 25.0%; p < 0.001), surgical complications (22 patients, 5.4% vs. 45 patients, 11.1%; p = 0.003), medical complications (36 patients, 8.9% vs. 66 patients, 16.3%; p = 0.001), superficial surgical site infections (8 patients, 2.0% vs. 26 patients, 6.4%; p = 0.002), and bleeding requiring transfusion (2 patients, 0.5% vs. 13 patients, 3.2%; p = 0.004). Robotic surgery also reduced length of stay (3.26 days vs. 6.08 days; p < 0.001). Multivariate analysis confirmed robotic technique as an independent protective factor against postoperative complications (OR: 0.414; p < 0.001). (OR: 0.414; p < 0.001).

Conclusion: Robotic-assisted PSH repair significantly reduces perioperative morbidity, complication rates, and hospital length of stay compared to open surgery. These results support robotic approaches as preferable for elective PSH repair.

Aim: The aim of this study was to explore patients' experiences of participation in a preoptimisation programme prior to ventral hernia repair, focusing on the programme's feasibility and patient-perceived potential.

Introduction: Preoptimisation of modifiable risk factors has received growing attention, but little is known about ventral hernia patients' perspectives on such programmes. Understanding patient motivation and perceived barriers is critical for designing effective interventions.

Method: Eight ventral hernia patients participated in a home-based preoptimisation programme lasting at least three weeks. Focus group interviews were conducted and analysed using reflexive thematic analysis.

Results: Participants generally perceived the preoptimisation programme positively. Clear and structured advice was valued, with participants appreciating straightforward instructions on physical activity and lifestyle change. Reported barriers included everyday life circumstances, orthopaedic comorbidities, and in some cases the hernia itself. Patients described perceived positive health effects, including improved fitness, weight loss, and better diabetes control. No adverse effects were raised during the interviews.

Conclusion: This is, to our knowledge, the first qualitative study of pre-optimisation programmes in ventral hernia surgery. As an exploratory, hypothesis-generating study, its findings are shaped by sample size and setting but provide novel insights that complement quantitative research by highlighting patient perspectives. Pre-optimisation programmes appear feasible and meaningful to ventral hernia patients, particularly when supported by clear guidance, structured follow-up, and surgeon involvement. The findings are discussed in the light of Self-Determination Theory, which emphasises internalisation of motivation through autonomy, competence, and relatedness.

Purpose: Incisional hernia is a common postoperative complication following abdominal surgery. Despite the use of synthetic meshes, recurrence rates remain high. This study aimed to develop and evaluate a biodegradable, aligned microfibrous scaffold to support wound healing and strengthen abdominal wall repair.

Methods: Scaffolds were fabricated from poly(ε-caprolactone) (PCL) using a controlled fiber-drawing technique to produce highly aligned microfibers with reproducible thickness and architecture. Their biocompatibility was examined in vitro using fibroblasts through adhesion and proliferation assays. For in vivo evaluation, the scaffolds were implanted over standardized abdominal wall incisions in rabbits. After six weeks, the regenerated tissue was harvested for mechanical testing to determine tensile strength and elasticity, while histological and immunohistochemical analyses assessed collagen type I deposition and neovascularization within the scaffold area.

Results: The aligned PCL scaffold promoted strong cell attachment and proliferation in vitro. In vivo, its application significantly increased tensile modulus compared with control wounds. Histological analysis revealed denser and more organized collagen deposition and a higher microvessel density in the scaffold-treated group, indicating enhanced tissue remodeling and vascular integration.

Conclusion: The aligned PCL microfibrous scaffold improved the mechanical and biological quality of the abdominal wall healing in vivo. These results suggest its potential for reducing the formation of incisional hernias and are suitable for further testing leading to use in clinical practice.