Hernia最新文献

Purpose: Pediatric inguinal hernia is one of the most frequent surgical conditions in children. Conventional open repair (OHR) has been regarded as the standard approach for decades; however, laparoscopic percutaneous extraperitoneal closure (LPEC), first described in Japan, has emerged as a minimally invasive alternative. This study aimed to systematically compare the clinical outcomes of LPEC with those of OHR in pediatric patients.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines (PROSPERO CRD42022349660). PubMed, Ichushi-Web, and Google Scholar were searched up to May 2022. Eligible studies included randomized and observational comparisons of LPEC (or equivalent percutaneous closure techniques) versus OHR in patients under 18 years. Outcomes assessed were recurrence, contralateral metachronous hernia (CMH), postoperative testicular ascent, and operative time for unilateral and bilateral repair. Study quality was evaluated using ROBINS-I, and certainty of evidence graded using GRADE methodology. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated.

Results: Ten studies with nearly 15,000 children were included. Recurrence did not differ significantly between LPEC and OHR (OR 1.34, 95% CI 0.84-2.16; I² = 0%). LPEC was associated with significantly lower risk of CMH (OR 16.53, 95% CI 10.13-26.98; I² = 0%) and testicular ascent (OR 2.51, 95% CI 1.11-5.67; I² = 0%). Unilateral LPEC required slightly longer operative time (MD + 3.11 min, 95% CI 2.53-3.70), while bilateral repairs were modestly faster (MD -6.21 min, 95% CI -8.02 to -4.40).

Conclusions: LPEC achieves recurrence outcomes equivalent to OHR while reducing contralateral hernia and testicular ascent, and improving efficiency in bilateral repairs. These findings support LPEC as a safe and effective first-line option for pediatric inguinal hernia.

Purpose: Traditional mesh fixation using tacks in laparoscopic repair of lateral incisional hernias (IHs) carries risks near sensitive anatomical areas. This retrospective cohort study evaluates the efficacy and safety of NBCA (n-butyl-2-cyanoacrylate) surgical glue as an alternative to tacks for mesh fixation.

Methods: Patients with primary lateral primary incisional hernias who were treated by laparoscopic technique in Department of Hernia and Abdominal Wall Surgery in Beijing Chaoyang Hospital from Jan 2017 to Dec 2023 were recruited in our study. Patients were divided into two groups: surgical glue with tacks group (GT, n=72) and tacks only group (TO, n=72). Demographics, operative details, hematoma, seroma, chronic pain, recurrence and other complications were retrospectively compared between the two groups.

Results: A total of 144 patients were recruited in our study. According to different fixation, there were 72 patients in GT group and 72 in TO group. Compared to TO group, the GT group had a significantly lower postoperative pain score at 24 hours, 72 hours and 120 hours(4.0vs.3.0, 3.0vs.2.0, 2.0vs.1.0, respectively, P<0.001). The recurrence was similar between the two group(2.7%vs.2.7%, respectively, P>0.05). GT group had a quicker time to return to normal activities(7vs.11days, respectively, P<0.001). The overall complication rates were equivalent between the two groups (9.7% vs.19.4%, respectively, P>0.05).

Conclusion: NBCA surgical glue may provide certain clinical advantages in laparoscopic lateral IH repair, including reduced postoperative pain and faster recovery, although the magnitude of pain reduction is modest. Glue-assisted fixation appears safe and does not increase recurrence or complication rates. Its use may be particularly beneficial in anatomically sensitive regions where traditional fixation poses higher risks. Further prospective multicenter studies are needed to confirm its long-term safety and effectiveness.

Background: A hernia is the abnormal protrusion of a viscus through a defect in the surrounding wall. Laparoscopic repair is increasingly favored over open surgery for ventral hernias due to its minimally invasive approach. However, consolidated evidence comparing their outcomes remains limited.

Objectives: This study aimed to compare outcomes including surgical site infection, hospital stay, operative time, and hernia recurrence between laparoscopic and open ventral hernia repair in adult patients, using evidence from randomized controlled trials and cohort studies.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library from 2000 to the current year. Eligible studies included randomized controlled trials and observational (prospective or retrospective cohort) studies comparing laparoscopic and open ventral hernia repair in adults (≥18 years) and reporting at least one of the outcomes of interest. Studies were excluded if they focused on pediatric populations, assessed only one outcome, or were case reports, meta-analyses, reviews, editorials, or studies addressing only inguinal/incisional hernias without specifying inclusion under ventral hernias. Risk of bias was assessed using the Cochrane RoB 2 tool and Newcastle-Ottawa Scale. Considering the included studies differed in clinical characteristics such as hernia type, defect size, mesh materials, fixation techniques, and surgeon experience a random effects model was selected before analysis as the most appropriate statistical approach, A random-effects meta-analysis was conducted and results presented narratively and using forest plots.hig.

Results: Nineteen studies (3 RCTs and 16 cohort studies; 7,826 patients) were included. Laparoscopic repair significantly reduced the risk of surgical site infection (RR = 0.36, 95% CI: 0.24-0.53) and shortened hospital stay (mean difference = -2.02 days, 95% CI: -2.15 to -1.89). Operative time was modestly longer with laparoscopy (mean difference= 9.44 minutes, 95% CI: 6.74 to 12.15). No significant difference in hernia recurrence was observed (RR = 1.03, 95% CI: 0.80-1.32). High heterogeneity was observed for hospital stay and operative time (I²= 98-99%), Subgroup analyses by hernia type and mesh placement were conducted to explore potential sources of variability. Funnel plot asymmetry suggested possible publication bias for hospital stay.

Discussion: Laparoscopic ventral hernia repair appears to be associated with reduced surgical site infection and shorter hospitalization, without increasing recurrence risk. Some of these findings however must be interpreted with caution given the substantial heterogeneity observed in operative time and hospital stay. Variability in outcome reporting and study design also limits generalizability of the findings.

Background: The administration of an antibiotic prophylaxis prior to Lichtenstein inguinal hernia repair is common. There is some scientific evidence supporting the use of prophylactic antibiotics as it can lower the rate of surgical site infections. The benefit prior to Shouldice Repair has not been previously investigated, thus, the study at hand was conducted to evaluate the benefit of an antibiotic prophylaxis in reducing surgical site infection (SSI) after Shouldice primary inguinal hernia Repair (SPIHR).

Methods: From July 2023 to August 2024 a prospective observational study was conducted at the Shouldice Hospital. The data of 2,000 consecutively enrolled eligible individuals who underwent SPIHR were analyzed. The primary objective was the rate of SSI at 30 days. As a hospital policy the administration of an antibiotic prophylaxis is the surgeon's choice. The endpoint assessment consisted of an emailed questionnaire and a telephone call from one general surgeon in the event of an SSI.

Results: The study population was made up of mostly males (average age of 62.10 ± 12.82 years and body mass index of 24.94 ± 2.49 kg/m²). A total of 1,390 individuals received an antibiotic prophylaxis whereas 610 did not. The baseline characteristics, including morbidity and smoking status, did not differ between the groups. Receiving antibiotics was associated with significantly lower SSI rates compared to those individuals that did not receive antibiotics (n = 12/610, 2.0% versus n = 6/1,390, 0.4%; p < 0.001).

Conclusion: The overall SSI rate detected 30 days after SPIHR was 0.9%. Administration of an antibiotic prophylaxis prior to SPIHR lowers the rate of SSI at Shouldice Hospital.

Purpose: To investigate the outcomes of a two-staged approach involving mesh explantation surgery in patients with chronic mesh infection (CMI) following hernia repair.

Methods: A retrospective review of patients who underwent mesh explantation for CMI after ventral and inguinal hernia repair (2011-2019) using electronic database records.

Results: Sixty-four patients (41 M, 23 F) included in this study had a mean age and BMI of 46.5 and 26.7, respectively. The most commonly isolated organism was Staphylococcus aureus (23.5%). Complete mesh explantation was performed in 41 patients, partial in 17, and debridement in 5 others. One patient underwent single-stage hernia mesh repair using biological mesh. Among the other 63, 22 (35%) had recurrent hernia after mesh explantation (mean follow-up: 4 years), 14 underwent hernia mesh repair, and eight were lost to follow-up; 41 (65%) remained recurrence-free after mesh explantation over a mean follow-up of 4 years (SD +/- 2.18 years). The recurrence rate after mesh explantation was significantly lower in patients with inguinal hernias (16%, 4/25) than in those with ventral hernias (46.2%, 18/39; p = 0.046).

Conclusion: Chronic mesh infections following hernia repair pose a formidable challenge to surgeons. It is better handled at specialized centers. We suggest complete mesh explantation in such patients and staged repair in the event of a hernia recurrence.

Purpose: Surgical Site Infection (SSI) is the common consequence of hernia surgery. This study aimed to develop an artificial intelligence (AI)-driven predictive model for SSI following open ventral hernia repair using pre- and intra-operative parameters for early detection.

Methods: A prospective analysis of ventral hernia patients was conducted. Demographic, pre-operative and intra-operative parameters were collected. Feature selection using Recursive Feature Elimination (RFE) identified key predictors. Five models, eXtreme Gradient Boosting (XGBoost), logistic regression, support vector machine (SVM), Adaptive Boosting and random forest (RF), were trained and validated.

Results: Among 253 patients, 22 were SSI-positive. RF demonstrated the highest predictive power (area under receiver operating characteristic curve = 0.82) and diagnostic odds ratio (DOR = 55). Seven key predictors were identified: defect size area, HbA1c, lymphocytes, neutrophil-to-lymphocyte ratio, blood loss (ml), platelet count and serum albumin. Decision curve analysis showed an estimated risk stratification at an 8.3% cutoff " https://surgicut-ai.netlify.app/ ".

Conclusion: The model's high accuracy supports its potential for clinical decision-making. External validation is required for real-world application. Integrating this AI model into bedside tools may enhance SSI prevention, especially in resource-limited settings.

Purpose: Incisional hernias (IH) are a frequent complication after laparotomy, contributing to patient morbidity and increased healthcare costs. While guidelines recommend prophylactic mesh reinforcement (PMR) in high-risk elective surgeries, there are no specific recommendations for contaminated/emergency settings. The retromuscular plane is considered optimal for mesh placement due to its favourable outcomes. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of retromuscular PMR in reducing IH rates following elective and contaminated/emergency midline laparotomies.

Methods: Following the PICO framework, we included studies assessing patients undergoing elective or contaminated/emergency midline laparotomies. The intervention was retromuscular PMR compared to primary suture closure (PSC). The primary outcome was IH incidence, with surgical site infection (SSI), seroma, and hematoma as secondary outcomes. A systematic literature search was conducted in Medline, Embase, Web of Science and Cochrane Library, the last search was completed on March 7th, 2025. Risk of bias was assessed using the RoB 2 tool. A random-effects meta-analysis was performed, with subgroup analyses by mesh type and surgical setting.

Results: Eight randomized controlled trials totalizing 1167 patients were included. PMR significantly reduced the risk of incisional hernia at the longest available follow-up compared to primary suture closure (OR 0.37, 95% CI 0.17-0.80), but heterogeneity was high (I² = 74%). Subgroup analysis showed benefit with synthetic mesh (OR 0.18, 95% CI 0.06-0.52) but not with biologic mesh. No significant differences were observed in surgical site infection, while non-significant trends toward increased seroma (OR 1.97) and hematoma (OR 3.05) were noted. Evidence in contaminated/emergency settings was limited and exploratory.

Conclusion: Retromuscular prophylactic mesh reinforcement reduces incisional hernia incidence in elective laparotomy, particularly with synthetic mesh, without increasing major infectious complications. However, substantial heterogeneity across studies limits the certainty of effect estimates, and evidence in contaminated or emergency surgery remains insufficient.

Systematic review registration: PROSPERO CRD42025632413.