Hernia最新文献

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.

Introduction: Active smoking is widely regarded as a risk factor for wound morbidity and adverse outcomes in abdominal wall reconstruction (AWR), often serving as a contraindication to elective repair. However, its independent impact on long-term complications remains poorly characterized.

Methods: This study utilized the prospectively maintained ACHQC registry, included patients who underwent open, elective, clean ventral hernia repair (VHR) with transversus abdominis release (TAR) and permanent synthetic mesh at a high-volume AWR center between February 2019 and December 2022. All active smokers during this period were propensity matched in a 1:3 ratio to never-smokers based on demographics, comorbidities, and operative characteristics. Outcomes were assessed at early (30-day) and long-term (≥ 24 months) timepoints. Primary endpoints included wound morbidity, mesh-related complications and hernia recurrence.

Results: A total of 106 active smokers were propensity-matched to 295 never-smokers. Baseline demographics and operative variables were well balanced. At 30 days, there were no significant differences in surgical site infection (SSI) (9.4% vs. 9.2%, p = 0.92), surgical site occurrence (SSO) (21.5% vs. 17.6%, p = 0.48), or surgical site occurrence requiring procedural intervention (SSOPI) (9.4% vs. 9.2%, p = 0.92). At 24 months, rates of SSO (1.9% vs. 0.7%, p = 0.81), SSI (0% vs. 0.3%, p > 0.99), SSOPI (0% vs. 0.7%, p > 0.99), mesh infection (0.9% vs. 0%, p > 0.99), and reoperation were low and statistically similar. Hernia recurrence at ≥ 24 months was 4.7% in smokers vs. 7.8% in never-smokers (p = 0.15).

Conclusion: In this analysis, active smoking was not associated with increased risk of clinically significant wound morbidity, mesh-related complications, SSOPI, or hernia recurrence. These findings support a patient-centered approach wherein smoking cessation is strongly encouraged but not mandated prior to surgical repair in appropriately selected individuals.

Background: Incisional ventral hernia repair remains important and one of the most complex problems in abdominal wall reconstruction surgery. Introduction of extended-view totally extraperitoneal (eTEP) approach changed significantly the concept of incisional ventral hernia repair. However, long-term results for the eTEP Rives-Stoppa (eTEP RS) remains under-investigated. This study aimed to evaluate the long-term outcomes of IPOM plus and eTEP RS techniques for midline incisional ventral hernias based on CT scan data and quality-of-life (QoL) assessment.

Materials and methods: A single-center, retrospective cohort study was conducted based on data from 117 patients with midline incisional ventral hernias who underwent either IPOM plus (n = 42), or eTEP RS (n = 75) from March 2018 to December 2022. Long-term outcomes were assessed by physical examination and CT scans at rest and during the Valsalva maneuver with a follow-up of more than one and half year. QoL was assessed using the Carolinas Comfort Scale (CCS) and the EuraHS quality-of-life score (EuraHS-QoL).

Results: Early postoperative complications were comparable; a larger mesh size was used in the eTEP RS group (p < 0.001). Long-term outcomes, assessed in 80 (68.4%) patients, demonstrated a significantly lower hernia recurrence rate in the eTEP RS group (2% vs. 19.3%, p = 0.012). A normal postoperative CT scan (without postoperative abdominal wall changes) was confirmed in 89.8% of eTEP RS patients and 58.1% in the IPOM plus group (p = 0.0009). Both the CCS and EuraHS-QoL scores were significantly better in the eTEP RS group (p < 0.05). Patients with normal CT scans had better results of QoL comparing with those who had recurrence, posterior rectus sheath (PRS) rupture or bulging.

Conclusion: Long-term follow-up demonstrates less hernia recurrence rate and higher QoL for eTEP RS in comparison with IPOM plus procedure for midline incisional ventral hernia repair that does not require separation of components. Bulging should be considered as a significant adverse event along with recurrence, since both are associated with a deterioration in the QoL. Prospective trials are needed to determine the optimal technique of minimally invasive procedure for midline ventral hernia repair.