Hernia最新文献

Purpose: Incisional and ventral hernia pose a complex surgical challenge with no consensus on the most appropriate repair technique. This study aimed to compare the short-term and long-term outcomes following open and minimally invasive techniques of incisional and ventral hernia repair.

Methods: Electronic search was conducted in PubMed, Scopus, Embase, Web of Science, LILACS and Cochrane CENTRAL databases, and Google Scholar, last date of search being 1^st January, 2025, to identify randomized trials comparing any two techniques of incisional and ventral hernia repair in adults, based on clinical outcomes such as recurrence, intraoperative and postoperative complications, or patient-reported outcomes. Risk of bias was assessed using Cochrane RoB2 tool. Statistical analysis was done using MetaInsight v6.0.1 and Stata version 16, using a random-effects model.

Results: Overall, 3229 articles were retrieved, of which 45 full texts were screened. Finally, 28 eligible studies, involving 3,162 patients were analysed. High risk of bias was observed in majority of studies. The primary outcomes of recurrence, and quality of life (QoL) were comparable across different techniques. Operative time was significantly longer in the robotic technique while length of hospital stay was significantly longer for the open technique. There were no significant differences in terms of intraoperative or postoperative complications. GRADE approach revealed quality of evidence to be low to moderate.

Conclusions: All open and minimally invasive techniques are essentially comparable in terms of short-term and long-term outcomes. An individualized approach can thus be expected to render excellent outcomes following any repair technique.

Background: Laparoscopic ventral hernia repair (LVHR) is widely used due to its minimally invasive benefits. However, traditional IPOM without fascial defect closure (FDC) has been associated with variable complications, prompting interest in techniques incorporating FDC, such as IPOM-plus and hybrid approaches. Ventral hernia repair remains a common surgical procedure, yet the optimal management of the FDC versus non-FDC remains controversial. We conducted this systematic review and meta-analysis to compare the safety and efficacy of these methods.

Methods: We searched PubMed, Web of Science, SCOPUS, CENTRAL, and Clinicaltrials.gov up to September 2025. Randomized controlled trials (RCT) comparing fascial defect closure versus non-closure in LVHR were eligible. Pooled effect was calculated by Random-effect model with 95%CI. Heterogeneity was assessed using the I² tool. Sensitivity, subgroup analyses, and trial sequential analysis were performed to assess the robustness of the results.PROSPERO ID: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251231261 .

Results: Thirteen RCTs, comprising a total of 1482 patients, were included. No significant difference was found between the FDC and the non-FDC in terms of diagnosis of recurrence radiologically (OR:0.69,95%CI: [0.33; 1.42], p = 0.3103) or clinically (OR:0.70,95%CI: [0.39; 1.26], p = 0.2357), or in diagnosis of seroma radiologically (OR:0.68,[0.33; 1.40], p = 0.2987) or clinically (OR:0.79, 95%CI: [0.49; 1.26], p = 0.3205). FDC was associated with longer operative time (MD:7.64,95%CI: [2.33; 12.95], p = 0.0048) and slightly higher postoperative pain (at day-1:SMD:0.36,95%CI: [0.07; 0.65]) and at day-2:SMD:0.31,95%CI: [0.05; 0.57], p = 0.0175). Secondary outcomes, including infection, mesh bulging, reoperation for recurrence, chronic pain, and quality of life, were also found to be statistically insignificant. Trial sequential analysis reinforced the inconclusiveness of the evidence and that additional trials are needed.

Limitation: Despite we included only RCTs, the available evidence is limited by inadequate reporting of hernia defect size and insufficient follow-up durations, which restrict definitive recommendations for routine FDC.

Conclusion: FDC and non-FDC were comparable in terms of LVHR in recurrence and seroma rates. FDC was associated with longer operative time and post-operative pain. The current available evidence is insufficient to support the routine use of FDC, and further randomized trials are needed to explore its role and accurately identify patients who would benefit the most.

Background: Lateral hernias are uncommon abdominal wall defects that pose significant surgical challenges due to their unique anatomy and limited published data guiding repair methods. This study aims to evaluate the feasibility and short-term outcomes of a robotic assisted minimally invasive approach for lateral hernia repair.

Methods: A single-institution, retrospective case series was conducted with 15 patients who underwent robotic preperitoneal lateral hernia repair. Demographics, operative considerations, and short-term outcomes were recorded and analyzed.

Results: The median age was 65 years, 73% were females (n = 11), and median body mass index was 29 kg/m². American Society of Anesthesiology classes were 3 (n = 11; 73%) and 2 (n = 4; 27%). Most hernias were incisional (n = 10), with traumatic (n = 2), and superior lumbar (n = 2) comprising the remainder. Left sided (n = 13) hernias were more common than right (n = 2). Two were recurrent with prior mesh. Median defect length and width were 7 and 9 cm, respectively. Median operative time was 199 min, and median blood loss was 20 mL. Median follow-up time was 180 days. Of the 12 cases who returned for follow-up, there was 1 (8%) recurrence, 1 (8%) reoperation and readmission after 30 days. The most frequent 30-day complication was a self-resolving seroma. (n = 3.20%), and no mortalities were observed.

Conclusions: Our case series of 15 patients indicates robotic-assisted lateral hernia repair as a feasible approach with acceptable short and mid-term outcomes, though interpretation is limited by small sample size and variable follow-up. Preoperative imaging and in-depth knowledge of lateral anatomy proved essential for optimizing outcomes.