Hernia最新文献

Purpose: The purpose of this study was to identify patient and operative factors that increase the likelihood of VTE after RVHR.

Methods: Patients aged 18 and older who underwent RVHR for a midline ventral hernia with 30-day follow-up in the Abdominal Core Health Quality Collaborative (ACHQC) database were included. Those who were under 18 years of age, had incomplete 30-day follow-up, lacked operative details, and or had inguinal or lateral abdominal wall hernia repair were excluded. A variety of patient demographic and operative factors were collected. Chi-squared tests were used to evaluate significance. A p-value of 0.05 was used as the level of statistical significance.

Results: 7422 patients were included in the final study. BMI > 30 (p = 0.0061), age > 60 (p < 0.0001), ASA class (p = 0.0002), median hernia size (p < 0.0001), prior mesh placement (p = 0.0003), and hernia recurrence (p = 0.0043) were significantly associated with VTE. Operative approach (p = 0.562), OR time > 2 h (p = 0.0708), males (p = 0.9924), diabetes (p = 0.4256), history of abdominal wall SSI (p = 0.3793), and any intraoperative complication (p = 0.3277) were not significantly associated with VTE.

Conclusion: Beyond established patient factors, larger defect width was independently associated with 30-day VTE after RVHR. Complexity markers-including recurrent hernia, prior mesh, and larger mesh dimensions-also tracked with VTE, and pre-operative anticoagulant therapy was more frequent among VTE cases, informing RVHR specific risk stratification and prophylaxis.

Aim: Surgical experience is essential for mastering operative techniques, yet quantifying this experience and linking it to patient outcomes remains challenging. This study aims to evaluate whether annual surgeon volume influences postoperative complications following inguinal hernia repairs (IHR).

Material and methods: PubMed/MEDLINE, EMBASE, and Cochrane Central were systematically searched for studies comparing surgeon annual case volume and reoperation rates after IHR. Surgeons were stratified into three volume categories: high-volume (> 50 cases/year), middle-volume (25-50 cases/year), and low-volume (< 25 cases/year) -based on thresholds adapted from a previously published systematic review.

Results: A total of 143 studies were screened, and ten studies were ultimately included in this review. A total of 544,700 patients who underwent IHR performed by 5,547 surgeons were included. Most cases were performed using an open approach (445,193; 81.7%) followed by laparoscopic (98,014; 18%) and robotic repair (1,493; 0.3%). Among patients undergoing open repair, reoperation rates were higher in the low-volume surgeon group (2.48%) compared to middle- (1.8%) and high-volume groups (2.05%). A similar trend was observed in laparoscopic repairs, with high-volume surgeons demonstrating lower reoperation rates (2.06%) compared to low-volume surgeons (3.3%). For robotic repairs, only one study reported outcomes; therefore, no definitive conclusions could be drawn regarding the association between surgeon volume and outcomes. Two studies compared only two individual surgeons and lacked generalizability. The other two studies found that surgeons performing more than 25 cases per year had lower recurrence rates (ranging from 0.7% to 0.8%) compared to low-volume surgeons (< 25 cases/year), whose recurrence rates ranged from 1.0% to 2.9%. Intraoperative complications, chronic pain, and mean operative time were also generally lower among patients treated by high-volume surgeons. A meta-analysis was not performed due to substantial heterogeneity among the included studies, particularly regarding the definitions of surgeon experience. There was no standardized threshold across studies to distinguish between experienced and inexperienced surgeons.

Conclusion: Lower surgeon volume was generally associated with higher reoperation rates. However, the differences between middle- and high-volume surgeons were small and unlikely to be clinically meaningful. Variability in surgical technique, mesh use, definitions of experience, and hernia complexity contributed to significant heterogeneity, limiting the strength of conclusions. Although inguinal hernia repair is a common procedure, it requires refined surgical judgment and adequate case exposure. Further prospective studies are needed to clarify the true impact of surgeon experience on patient outcomes.

Background: Robotic-assisted transabdominal preperitoneal (r-TAPP) inguinal hernia repair is increasingly adopted, yet its short-term advantages over conventional laparoscopy remain uncertain.

Methods: This systematic review was reported according to PRISMA guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL until September 25th, 2025. Randomized controlled trials (RCTs) comparing r-TAPP and laparoscopic TAPP were eligible. Primary outcomes were operative time and postoperative complications. A random effects model was used for meta-analysis, and study quality was assessed using the Cochrane RoB II tool.

Results: Three RCTs comprising 300 patients were analyzed. Robotic repair was associated with a longer operative time, though this did not reach statistical significance (MD + 17.6 min; 95% CI - 20.7 to + 55.9; p = 0.37). Complication rates were not significantly different (RR 0.83; 95% CI 0.34-2.03; p = 0.68). Readmissions were rare and comparable between groups (RR 0.71; 95% CI 0.09-5.58; p = 0.74).

Conclusions: Robotic TAPP is safe and effective; however, clear superiority over laparoscopy has not been established. Large-scale, multicenter RCTs with standardized protocols, long-term follow-up, and cost-effectiveness analyses are needed to clarify the role of robotics in inguinal hernia repair.

Prospero registry: Registration number: CRD420251157847.

Background: Incisional ventral hernia repair is a complex problem. Rives-Stoppa technique is the most common procedure for patients with large incisional hernias. However, in cases of incisional hernias with a large defect width and/or the rectus to defect ratio (RDR) of less than 2, component separation is often required. At the same time, posterior component separation (PCS) is a technically challenging procedure. Currently, the evaluation of postoperative outcomes after PCS is primarily based on analysis of wound morbidity and recurrence rate. The aim of our study was to evaluate long-term surgical outcome after different types of PCS for midline incisional ventral hernias based on postoperative CT data and patient-reported outcome.

Materials and methods: Our study is a retrospective analysis of a prospectively collected database from 2017 to 2022 for patients with midline incisional hernia after different types of bilateral PCS (eTAR/TAR or Carbonell). All patients were evaluated by physical examination, a low dose computed tomography (CT) of the abdominal wall and quality of life assessment by EuraHS score.

Results: Total of 180 patients with midline incisional ventral hernia underwent Rives-Stoppa repair in combination with bilateral PCS. Long-term results were obtained in 120 patients (66.7%). According to CT data, most patients (79%) did not have any pathological changes of abdominal wall. Unfavorable outcomes were diagnosed in 24 patients (20.0%). We interpreted unfavorable outcomes as the presence of recurrence or interparietal hernia (IPH), or a combination of both. A total of 8 recurrences were identified: 3 - in open TAR group, 3 - in Carbonell group and 2 recurrences in eTAR group. A total of 20 (16.7%) postoperative IPH were revealed based on CT scans. The overall values of EuraHS-QoL score were significantly higher in the group with CT-complications (8 (4-15) vs. 4 (0-10), p = 0.024).

Conclusion: Detection of interparietal hernia for comprehensive long-term outcomes after posterior component separation is equally important as recurrence, because both can influence on quality of life.

Purpose: Parastomal hernias are a common complication after ostomy creation with high morbidity. Minimally invasive Sugarbaker mesh-based repairs have shown improved outcomes. Laparoscopic (LPHR) and robotic-assisted (RPHR) Sugarbaker parastomal hernia repairs were compared.

Methods: Retrospective analysis of the Abdominal Core Health Quality Collaborative (ACHQC) database was conducted for elective, minimally invasive Sugarbaker parastomal hernia repair with permanent synthetic mesh from January 2014 to December 2023. Patients were grouped by surgical approach: RPHR or LPHR. Primary outcome was pragmatic hernia recurrence. Secondary outcomes included average pain intensity, hernia-related quality of life, and 30/90-day complications. Statistical analyses included chi-square, t-tests, and Mann-Whitney U tests.

Results: Three hundred sixty-eight patients were included (RPHR: n = 260; LPHR: n = 108). Demographics and comorbidities were similar. RPHR involved more mesh excisions (37.5% vs. 4.3%; P = .009), hernia with longer lengths (8.3 cm vs. 6.4 cm; P < .001), and more frequent fascial closure (94.4% vs. 48.1%; P < .001). Recurrence within one year was lower after RPHR (20.9% vs. 40.5%; P = .03), but no significant differences were observed between postoperative years one through six. No differences in pain or quality-of-life outcomes were noted between groups, but both groups demonstrated significant improvements in hernia-related quality-of-life over one year.

Conclusion: Recurrence within one year was lower after RPHR compared to LPHR. Longer-term recurrence rates were similar between approaches. However, long-term recurrence findings are limited by low follow-up rates. Both approaches significantly improved hernia-related quality-of-life. Over time, recurrence may be more dependent on the altered anatomy and physiology of the stoma-affected abdominal wall rather than the specific minimally invasive approach used.

Abcstrat: PURPOSE: Parastomal hernia is a common complication that may require emergency repair (ePHR). Although 20% of PHRs are performed in an emergency setting, treatment strategies and outcomes are poorly documented. This systematic review aimed to determine the optimal strategy and surgical technique for ePHR.

Methods: A literature search was conducted in PubMed, Embase, Web of Science, CINAHL, Cochrane Library and Google Scholar for original studies reporting on ePHR. Primary outcome was rate of reoperation within 90 days. Secondary outcomes were length of stay (LOS) as well as 90-day rates of surgical site infection (SSI), other complications, and mortality.

Results: The search identified 328 studies of which 10 was included totalling 21,877 patients undergoing ePHR. Mean rates for short-term reoperation, SSI, other complications and mortality were 39% (95%-confidence interval 31-49%), 24% (15-37%), 44% (30-59%) and 12% (8-16%), respectively. Median LOS varied between 7 and 13 days. Insufficient data precluded meta-analysis for comparison of (1) open and laparoscopic repair, (2) local repair, relocation and reversal, as well as (3) mesh and suture repair.

Conclusion: Besides considerable LOS, ePHR was associated with high morbidity and mortality. The limited available literature and conflicting data did not entitle recommendation of a specific surgical approach for this patient group. There was no evidence that suggested mesh should be avoided in ePHR. Future studies should investigate a two-stage approach with initial damage control versus one-stage definitive repair. Moreover, studies are warranted to compare open and minimally invasive surgery for ePHR.

Introduction: Inguinal hernia is a common occurrence affecting one in four men. Recurrence is a major clinical pitfall that affects about 10% of patients with increased recurrence and postoperative complications after a revision repair. Reoperation due to metachronous contralateral inguinal hernia is another possible outcome. The impact of minimally invasive surgery (MIS) techniques on inguinal hernia recurrence rates as compared to open surgery is less clear and further confounded by the adoption of robotic approaches. The aim of this study was to compare reoperation rates.

Methods: Adult patients who underwent primary unilateral inguinal hernia repair (IHR) in an outpatient setting between January 2015 and December 2021 were queried from the Merative^TM MarketScan® Research Databases. Reoperation for IHR within two years was compared across surgical approaches: Open (O-IHR), Laparoscopic (L-IHR), and Robotic (R-IHR). Reoperations were further categorized and analyzed separately for recurrent and non-recurrent IHR. Secondary outcomes included all-cause total healthcare expenditures, assessed during the index operation and up to two years postoperatively, based on combined insurer and patient payments. A 1:1 propensity score matching approach was applied, with Cox proportional hazards regression used to analyze reoperation risk, and generalized linear regression models employed to evaluate expenditures.

Results: A total of 73,870 patients undergoing IHR (39,591 [53.6%] O-IHR, 30,858 [41.8%] L-IHR, and 3,421 [4.6%] R-IHR) were included. As compared to O-IHR, any IHR reoperation risk at 2-years was about 42% lower with R-IHR (HR = 0.58, p = 0.002) and about 16% lower with L-IHR (HR= 0.84, p < .001). As compared to O-IHR, total expenditure for the index surgery was approximately $3,391 higher with L-IHR (p < .001) and $4,137 higher with R-IHR (p < .001). R-IHR had about $615 higher index expenditure than L-IHR (p = 0.004).

Conclusion: The current study demonstrates that robotic IHR is associated with a lower risk of reoperations at 2 years after an initial repair as compared to L-IHR and O-IHR, but higher index expenditure in the outpatient setting for an economically active population.

Purpose: The use of robotic-assisted ventral hernia repair (rVHR) has expanded rapidly, but its economic viability remains debated. This study aimed to provide a transparent cost analysis of rVHR compared with open ventral hernia repair (oVHR), and to identify patient subgroups where rVHR may represent a cost-effective alternative.

Methods: Patients with midline ventral hernias were randomized to rVHR or oVHR. A detailed bottom-up costing approach was applied, including preoperative, intraoperative, hospitalization, and post-hospitalization costs, as well as capital and maintenance costs of the robotic platform. Group-specific mean costs were estimated using log-linear regression models. Cost-consequence and cost-effectiveness analyses were performed, and an interaction model was used to explore cost differences in relation to hernia defect size.

Results: Fifty-six patients were included (29 rVHR, 27 oVHR). Mean total hospital costs were significantly higher for rVHR (€3,539) compared with oVHR (€1,696; cost ratio 2.09, p <0.001). Instrumentation and consumables accounted for the largest share of rVHR costs, while hospitalization represented the largest component in oVHR. Modeling suggested a potential crossover point at a defect size of 56 cm², beyond which rVHR could become relatively more cost-effective. The cost-effectiveness analysis showed that robotic-assisted surgery required an additional €1,149 to reduce hospital stay by one day.

Conclusion: Robotic-assisted ventral hernia repair is associated with substantially higher costs than open repair in our setting. However, rVHR may represent a more cost-effective strategy for larger or more complex hernias, supporting selective use based on patient characteristics and institutional resources.

Purpose: To evaluate short and long-term outcomes of bilateral groin hernia (BGH) repair using an open preperitoneal approach (OPA) compared to minimally invasive surgery (MIS) in ambulatory surgery.

Methods: A retrospective cohort study was conducted including patients undergoing ambulatory BGH repair between 2010 and 2018 at Vall d'Hebron University Hospital (Barcelona) using either OPA (a modified Wantz technique) or MIS [transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP)]. Demographic, perioperative, and postoperative data were analysed. Chronic postoperative inguinal pain (CPIP) was assessed at two time points: early (3-12 months) and late (> 12 months postoperatively). Long-term follow-up was conducted through structured telephone interviews using the Hernia Recurrence Inventory survey. Multivariate logistic regression and ROC analysis were used to identify predictors of CPIP.

Results: A total of 244 patients (488 hernias) met the inclusion criteria, with a median follow-up of 116 months. OPA patients were older and had more comorbidities (P < 0.001). Operative time was shorter in the OPA group (median 70 vs. 110 min; P < 0.001). No significant differences were found in recurrence rates or surgical site occurrences. Multivariate analysis showed that OPA was independently associated with a lower risk of CPIP between 3-12 months postoperatively (OR 0.091, P < 0.001) compared to MIS. At long-term follow-up, higher Body Mass Index (BMI) was the only factor associated with persistent pain (OR 1.2, P = 0.024).

Conclusion: OPA is a safe and effective technique for BGH repair, offering shorter operative times and lower risk of CPIP between 3-12 months postoperatively compared to MIS, while maintaining comparable long-term outcomes (> 12 months).