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.