Hernia最新文献

Purpose: To investigate the outcomes of a two-staged approach involving mesh explantation surgery in patients with chronic mesh infection (CMI) following hernia repair.

Methods: A retrospective review of patients who underwent mesh explantation for CMI after ventral and inguinal hernia repair (2011-2019) using electronic database records.

Results: Sixty-four patients (41 M, 23 F) included in this study had a mean age and BMI of 46.5 and 26.7, respectively. The most commonly isolated organism was Staphylococcus aureus (23.5%). Complete mesh explantation was performed in 41 patients, partial in 17, and debridement in 5 others. One patient underwent single-stage hernia mesh repair using biological mesh. Among the other 63, 22 (35%) had recurrent hernia after mesh explantation (mean follow-up: 4 years), 14 underwent hernia mesh repair, and eight were lost to follow-up; 41 (65%) remained recurrence-free after mesh explantation over a mean follow-up of 4 years (SD +/- 2.18 years). The recurrence rate after mesh explantation was significantly lower in patients with inguinal hernias (16%, 4/25) than in those with ventral hernias (46.2%, 18/39; p = 0.046).

Conclusion: Chronic mesh infections following hernia repair pose a formidable challenge to surgeons. It is better handled at specialized centers. We suggest complete mesh explantation in such patients and staged repair in the event of a hernia recurrence.

Purpose: Surgical Site Infection (SSI) is the common consequence of hernia surgery. This study aimed to develop an artificial intelligence (AI)-driven predictive model for SSI following open ventral hernia repair using pre- and intra-operative parameters for early detection.

Methods: A prospective analysis of ventral hernia patients was conducted. Demographic, pre-operative and intra-operative parameters were collected. Feature selection using Recursive Feature Elimination (RFE) identified key predictors. Five models, eXtreme Gradient Boosting (XGBoost), logistic regression, support vector machine (SVM), Adaptive Boosting and random forest (RF), were trained and validated.

Results: Among 253 patients, 22 were SSI-positive. RF demonstrated the highest predictive power (area under receiver operating characteristic curve = 0.82) and diagnostic odds ratio (DOR = 55). Seven key predictors were identified: defect size area, HbA1c, lymphocytes, neutrophil-to-lymphocyte ratio, blood loss (ml), platelet count and serum albumin. Decision curve analysis showed an estimated risk stratification at an 8.3% cutoff " https://surgicut-ai.netlify.app/ ".

Conclusion: The model's high accuracy supports its potential for clinical decision-making. External validation is required for real-world application. Integrating this AI model into bedside tools may enhance SSI prevention, especially in resource-limited settings.

Purpose: Incisional hernias (IH) are a frequent complication after laparotomy, contributing to patient morbidity and increased healthcare costs. While guidelines recommend prophylactic mesh reinforcement (PMR) in high-risk elective surgeries, there are no specific recommendations for contaminated/emergency settings. The retromuscular plane is considered optimal for mesh placement due to its favourable outcomes. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of retromuscular PMR in reducing IH rates following elective and contaminated/emergency midline laparotomies.

Methods: Following the PICO framework, we included studies assessing patients undergoing elective or contaminated/emergency midline laparotomies. The intervention was retromuscular PMR compared to primary suture closure (PSC). The primary outcome was IH incidence, with surgical site infection (SSI), seroma, and hematoma as secondary outcomes. A systematic literature search was conducted in Medline, Embase, Web of Science and Cochrane Library, the last search was completed on March 7th, 2025. Risk of bias was assessed using the RoB 2 tool. A random-effects meta-analysis was performed, with subgroup analyses by mesh type and surgical setting.

Results: Eight randomized controlled trials totalizing 1167 patients were included. PMR significantly reduced the risk of incisional hernia at the longest available follow-up compared to primary suture closure (OR 0.37, 95% CI 0.17-0.80), but heterogeneity was high (I² = 74%). Subgroup analysis showed benefit with synthetic mesh (OR 0.18, 95% CI 0.06-0.52) but not with biologic mesh. No significant differences were observed in surgical site infection, while non-significant trends toward increased seroma (OR 1.97) and hematoma (OR 3.05) were noted. Evidence in contaminated/emergency settings was limited and exploratory.

Conclusion: Retromuscular prophylactic mesh reinforcement reduces incisional hernia incidence in elective laparotomy, particularly with synthetic mesh, without increasing major infectious complications. However, substantial heterogeneity across studies limits the certainty of effect estimates, and evidence in contaminated or emergency surgery remains insufficient.

Systematic review registration: PROSPERO CRD42025632413.

Purpose: The incidence of trocar site hernia (TSH) after bariatric surgery is unclear. This study aims to describe the cumulative incidence of ventral hernia surgery after laparoscopic bariatric surgery in total and by laparoscopic method (LRYGB; Roux-en-Y Gastric Bypass and LSG; Sleeve Gastrectomy).

Methods: This was a register based observational study on patients subjected to laparoscopic bariatric surgery (LRYGB or LSG) in Sweden 2009-2019. The Scandinavian Obesity Surgery Registry (SOReg) was linked to the Swedish National Patient Register (NPR) to obtain instances of ventral hernia surgery. Nearby codes were used as proxies for TSH surgery, since a specific procedure code for TSH surgery is lacking.

Results: In 64 124 patients, mean follow-up was 67 ± 36 months, LRYGB (n = 52 020) 74 ± 34 months and LSG (n = 12 104) 34 ± 22 months. Mean time between bariatric- and ventral hernia surgery was 36 ± 28 months (range 0-129). The five-year cumulative incidence of surgery for ventral hernia was 2.9% (CI 2.8-3.1). The probability of having hernia surgery was significantly higher for LRYGB compared to LSG (Breslow test, p < 0.001), still significant with differences in follow-up time accounted for (p < 0.001).

Conclusion: The incidence of surgery for ventral hernia after laparoscopic bariatric surgery is not negligible in this material covering over a decade of bariatric procedures. Ventral hernia surgery was more common after gastric bypass than after sleeve gastrectomy.

Purpose: Prehabilitation, including smoking cessation, weight loss, and glycemic control, has been shown to improve outcomes in abdominal wall reconstruction (AWR). While many AWR programs have adopted these strategies, it remains unclear how consistently general surgeons (GS) implement prehabilitation in elective AWR.

Methods: An 18-question anonymous survey was distributed via REDCap to GS at two tertiary care institutions with active AWR programs. Surgeons who performed hernia repair but were not members of the AWR programs were questioned. Descriptive statistics compared attitudes, practices, and institutional support across hospitals by surgical volume were performed.

Results: Surveys were sent to 57 GS at Hospital System 1 (HS1) and 27 GS at Hospital System 2 (HS2). Of 84 surveys, 28 GS responded, yielding response rates of 30% for HS1, 48% for HS2, and 33% overall. All respondents agreed that active smoking, obesity, and uncontrolled diabetes negatively impact AWR outcomes. However, less than one-third postpone surgery for smoking cessation (32%), weight loss (29%), HbA1C improvement (32%). Barriers included concern about surgical volume/income (25%), limited perceived support from colleagues (43%) or their institution (53%). Although 57% reported access to prehabilitation resources, only 13% consistently referred patients.

Conclusion: Despite strong evidence, unanimous agreement of its benefits, and active, institutional AWR programs that perform prehabilitation, this practice remains underutilized among general surgeons. Concerns about reduced operative volume, income, and colleague and institutional support are key barriers. Addressing these may increase prehabilitation utilization among GS and ultimately improve outcomes.

Background: Obesity increases the rate of postoperative wound complications for patients undergoing open abdominal wall reconstruction (AWR) and predisposes patients to hernia recurrence. While minimally invasive surgery (MIS) techniques minimize wound morbidity in obese patients, the exact degree to which this occurs remains unknown.

Methods: A prospectively maintained single-institution hernia database was queried for patients undergoing robotic-assisted (rTAR) from 2018 to 2024. Basic demographics, operative characteristics and postoperative outcomes were reviewed. A univariate analysis was performed to compare outcomes for patients with a BMI < 35 kg/m² (low BMI) to those with BMI ≥ 35 kg/m² (high BMI). The primary outcomes were 30-day surgical site infection (SSI) and hernia recurrence.

Results: There were 128 patients: 72 with low BMI and 56 with high BMI. Mean BMI for each group was 28.2±3.6 and 41.5±4.6 kg/m², respectively (p < 0.01). There were more recurrent hernias (8.3% vs. 25.0%, p = 0.01) and larger hernia defects (median(Q1-3)) (101(35-192) vs. 150(98-240) cm², p = 0.01) in the high BMI group. Most patients underwent bilateral TAR (69.4% vs. 73.2%, p = 0.70). There was no difference in SSI rate or (1.4% vs. 0.0%, p = 0.78) or hernia recurrence at 6 months (1.8% vs. 0.0%, p = 0.65). Quality of life outcomes were similar at 3 weeks and 6 months (each p > 0.05).

Conclusion: Despite having more complex hernias, the high and low BMI groups had comparable rates of 30-day SSI and short-term hernia recurrence. rTAR appears to be a safe and effective operation for patients with a BMI ≥ 35 kg/m².

Objectives: To determine the relative efficacy and safety of surgical techniques for parastomal hernia (PH) repair using a Bayesian network meta-analysis (NMA), integrating direct and indirect evidence to generate probabilistic rankings and guide clinical decision-making.

Methods: We conducted a systematic review and Bayesian NMA of 28 studies (1.983) patients) comparing seven PH repair techniques, following PRISMA-NMA guidelines. The primary outcome was parastomal hernia (PH) recurrence; the secondary outcome was cumulative postoperative complications. Random-effects models with a binomial likelihood and a logit link function were used. SUCRA probabilities ranked interventions; node-splitting assessed inconsistency; meta-regression evaluated covariates.

Results: FunnelMesh achieved the highest SUCRA score for recurrence reduction (91.55%), significantly outperforming Keyhole (OR 0.06, 95% CrI: 0.01-0.35) and Repair (OR 0.11, 95% CrI: 0.02-0.55). Sandwich ranked second (80%). For complications, Modified Keyhole (KeyholeM) ranked safest (SUCRA = 91%), with a significantly lower complication risk than Sugarbaker (OR = 0.23; 95% CrI: 0.05-0.94) and Keyhole (OR = 0.22; 95% CrI: 0.04-0.92). Node-splitting revealed inconsistencies in the FunnelMesh comparisons, warranting cautious interpretation. Meta-regression confirmed robustness across stoma type, approach, and follow-up duration.

Conclusions: FunnelMesh and Sandwich offered superior recurrence prevention; KeyholeM provides the optimal balance of low recurrence and minimal complications. The traditional Keyhole technique remained associated with high failure rates, reinforcing current guideline recommendations against its use. These findings provide an evidence-based framework to individualize PH repair strategies based on efficacy and safety trade-offs.

Highlights: Bayesian network meta-analysis comparing all major techniques for parastomal hernia repair. FunnelMesh, Sandwich, and modified Keyhole achieve the best balance of efficacy and safety. Provides an evidence-based framework to guide surgical selection and patient counseling.

Purpose: Mesh reinforcement is generally recommended in ventral hernia repair. This study examined temporal trends in mesh placement in elective ventral hernia repair over the past 18 years to better understand changes in clinical practice, with a secondary focus on trends in surgical approach.

Methods: This study utilized prospectively collected data from the Danish Ventral Hernia Database, covering the period from its inception in 2007 to 2024 in Denmark. Primary and incisional hernias with defect widths < 10 cm were included in the analysis.

Results: A total of 62,963 operations were included, with primary hernias accounting for 76% of cases. Mesh repair has increased over time, particularly for primary ventral hernias, rising from 820 cases (40.9%) in 2007 to 2,300 cases (80.6%) in 2024. Until around 2018, intraperitoneal onlay mesh (IPOM) placement was the most common repair technique for hernia defects > 1 cm. Its use then declined significantly and was surpassed by onlay for defects measuring ≤ 4 cm, followed by preperitoneal and retromuscular mesh placements. For defects > 4 cm, retromuscular placement became dominant (72% for incisional hernias in 2024; 54% for primary hernias). By 2024, the use of IPOM had become minimal across all defect sizes. Over the study period, laparoscopic repairs decreased, while open and robotic approaches increased.

Conclusion: Mesh placement has changed over time, and in the beginning of the 2010s, IPOM was the most commonly used placement, but its use declined and was replaced by extraperitoneal placements, with onlay preferred for small- and medium-sized defects and retromuscular for large defects. By 2024, the use of IPOM had become minimal. These shifts have not followed current evidence and may therefore reflect evolving surgeon preference. Stronger evidence is needed to guide best practices and improve patient outcomes.