Hernia最新文献

Purpose: During the COVID-19 pandemic, digital encounters became a crucial means of maintaining access to care amid restrictions on in-person interactions. As these limitations ease, it is essential to evaluate the outcomes of telehealth-based consultations. Before the pandemic, telehealth was predominantly used in postoperative care for surgical populations. This study examines the safety and efficacy of telehealth-based consultations compared to traditional in-person preoperative evaluations for small ventral hernia repair, contributing to the understanding of how telemedicine can be effectively integrated into surgical practices.

Methods: We utilized a prospectively maintained single-center database from a tertiary referral hospital with a specialized hernia and abdominal wall reconstruction team to compare preoperative, intraoperative, and postoperative variables between ventral hernia patients who received telehealth-based (phone or video) consultations and those who had any in-person clinic evaluation.

Results: A total of 187 patients with small (< 4 cm) ventral hernias were evaluated, with 42 (22%) being evaluated entirely through telemedicine-based consultations prior to their surgery. There were comparable post-operative outcomes for patients evaluated entirely virtually preoperative compared to those evaluated with at least one traditional in-person evaluation. In both cohorts, 52% of patients followed up at one-year through our hernia surveillance program. The unanticipated recurrence rates observed were 0% for digital pre-operative patients, and 2.01% for patients evaluated in person pre-operatively (p = 1).

Conclusions: Based on the data presented here, virtual preoperative encounters are as safe and effective as traditional in-person evaluations for patients with small ventral hernias.

Background: Incisional hernia (IH) is a significant complication that occurs after midline laparotomy and is associated with high morbidity and economic impacts. A fundamental goal of preventing IH is to determine which patients are considered low- or high-risk, as modifications in prevention techniques have been justified in high-risk patients.

Aim: of this study was to externally validate the IHXGBoost-P model to assess its accuracy, generalizability, and clinical applicability in an independent cohort.

Methods: A prospective cohort study was conducted in a tertiary hospital in Mexico (March 2021-December 2022) to externally validate the IHXGBoost-P model. Patients older than 18 years who underwent midline laparotomy and have a minimum follow-up of 24 months were included. The performance of the model was evaluated via area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, precision, specificity and calibration metrics.

Results: Of the 438 patients analyzed, 62 (14.1%) developed IH. The model demonstrated good discriminative capacity (Accuracy: 0.94 ± 0.015) and calibration (Brier score: 0.051). Key predictors included the risk of surgical site infection (odds ratio (OR): 3.01, 95% CI: 2.32-3.91), previous surgery, and body mass index (BMI). The specificity (0.97 ± 0.013) was determined to be high and useful for identifying lowrisk patients.

Conclusions: The IHXGBoost-P model is a reliable tool for predicting the risk of IH, with robust performance being observed in external validation. Its integration into clinical practice through a web application could optimize surgical decision-making to prevent IH.

Purpose: Inguinal hernias are commonly encountered during robotic-assisted radical prostatectomy (RARP), either preoperatively or intraoperatively. Performing concurrent inguinal hernia repair (IHR) at the time of RARP may prevent the morbidity, cost, and inconvenience associated with a second operation. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of concurrent IHR during RARP compared with RARP alone.

Methods: This study followed PRISMA guidelines and was prospectively registered with PROSPERO (CRD42025646245). Comprehensive searches of PubMed, EMBASE, and Cochrane CENTRAL were conducted to identify studies comparing outcomes of RARP with and without concurrent IHR. Primary outcomes included operative time, length of hospital stay, blood loss, and postoperative complications. A proportional meta-analysis was performed using a random-effects model, and heterogeneity was assessed using the I² statistic.

Results: Twenty studies comprising 1,402 patients who underwent concurrent IHR and 20,405 patients who underwent RARP alone were included. Concurrent IHR was associated with a statistically significant increase in operative time (mean difference 30.45 min; 95% CI 13.71-77.38) but showed no significant differences in postoperative complications, blood loss, or hospital stay. The pooled hernia recurrence rate was low (mean 1.9%), and Clavien-Dindo I-III complication rates were comparable between groups.

Conclusion: Concurrent IHR during RARP may be feasible, with perioperative outcomes broadly comparable to RARP alone. Concurrent repair may be considered in selected patients and experienced centres however given study heterogeneity and the predominance of retrospective evidence, these findings should be interpreted cautiously.

Trial registration: The trial was prospectively registered on PROSPERO on 03/02/2025 under ID: CRD42025646245.

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.