Hernia最新文献

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.

Purpose: Incisional hernia (IH) is the most common long-term complication following open pancreatic surgery. This study aimed to evaluate the transportability of the Penn Hernia Risk Calculator (PHRC) Hepato-Pancreato-Biliary (HPB) model in a geo-temporally diverse population.

Methods: Adult patients undergoing non-palliative pancreatic surgery via a transverse laparotomy from April 2012 to December 2023 at a single tertiary academic center were included. Patients with prior IH diagnosis and/or repair were excluded. Demographics, medical history, lab, and operative data were collected. Composite IH risk scores were calculated using the PHRC. Model performance was assessed using the Area Under the Receiver Operating Characteristic Curve (AUROC) and positive likelihood ratios (LR+) across risk thresholds.

Results: A total of 403 patients were included with 4.2% developing IH. The study population differed significantly from the PHRC cohort in 19 of 20 predictive variables. The overall AUROC was 0.548, and LR + values were consistently below 1.8 at all risk thresholds. Calibration plots indicated systematic overprediction of IH risk. Subgroup analysis showed improved performance (AUROC = 0.875, LR + = 0.467) among patients with BMI > 30 kg/m². Malignancy was a protective factor, while undergoing left hemipancreatectomy or central pancreatectomy and BMI 20-30 kg/m² were associated with IH development.

Conclusion: In this small single-center cohort, the PHRC HPB model demonstrated poor accuracy in predicting early IH following pancreatic surgery through transverse laparotomy. Performance improved in obese patients, suggesting case-mix and outcome incidence differences may largely explain the lack of model transportability.