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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.

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.