Hernia最新文献

Purpose: Parainguinal hernias (PHs) are an uncommon but under-recognised subtype of lateral abdominal wall hernia, located near the ASIS, distinct from the deep inguinal ring and at or just below the interspinous plane. They are frequently misclassified as Spigelian hernias (SHs) or inguinal hernias due to overlapping features. This study aimed to define the clinical characteristics, diagnostic accuracy, operative management, and long-term outcomes of patients with PHs compared with SHs.

Methods: A retrospective cohort study of all adult patients undergoing mesh repair for PHs or SHs under the care of a single surgeon between 2002 and 2025 was undertaken. Clinical, radiological, and operative findings were analysed alongside complications and long-term outcomes. Pain outcomes were assessed using Cunningham's criteria.

Results: Forty-five patients underwent surgical repair: 40 with PHs and five with SHs (41 PH and 5 SH repairs). PH patients were older than SH patients (median 72 vs. 58 years, p = 0.036). PHs were more often left-sided (63%) and commonly misdiagnosed preoperatively as SHs (51%). Clinical diagnosis of PHs showed moderate sensitivity (56%) but high positive predictive value (96%), while CT and ultrasound performed poorly (sensitivities 6-15%). SHs were more reliably identified clinically (80%) but had low predictive values. PHs were repaired predominantly with open or laparoscopy-assisted mesh repair (95%), while SHs were repaired laparoscopically in most cases (80%). Complications were rare (seroma 4%, TIA 2%). At a median follow-up of 8.8 years (IQR 2.4-12.5), 87% of patients reported no pain, 13% had mild symptoms, and there were two recurrences (4%).

Conclusion: PHs are more common than SHs, and recognition as a separate subtype is warranted to improve diagnostic accuracy and guide tailored management. In this series, open extraperitoneal mesh repair of PHs was associated with low complication rates, and excellent long-term patient outcomes.

Purpose: Polypropylene mesh is available in the configurations: knitted polypropylene (KP) and nonwoven polypropylene (NWP). Although there is robust literature regarding KP, there is a knowledge gap in the long-term performance of NWP in ventral hernia repair (VHR). We recently reported one-month outcomes of KP versus NWP mesh after VHR; however, long-term outcomes of NWP were not evaluated. This study aims to describe these long-term outcomes.

Methods: Patients who underwent open, clean VHR with Surgimesh WN, a heavyweight NWP mesh, from 2022 to 2025 with one year follow-up were included. Outcomes such as SSO (surgical site occurrence), SSI (surgical site infection), SSOPI (surgical site occurrence requiring procedural intervention), and hernia recurrence were reported at 30-day, one-year, and two-years. Hernia recurrence was defined pragmatically, a composite of patient-reported bulges, clinical exam, and cross-sectional imaging.

Results: 160 patients were included. Ventral hernias had a median width of 15 cm. At 30 days, there were 20 SSOs, six SSIs, eight SSOPIs, and no hernia recurrences. At one year, there were three SSOs, one SSI, one SSOPI, and no reoperations for recurrence. At two years (N = 35), there was one SSO and no hernia recurrences.

Conclusion: Our early experience with Surgimesh WN indicates it is a safe and effective for VHR. NWP mesh is especially useful given the 50cmx50cm available for large VHRs. Long term follow-up in larger cohorts is needed to support these findings and explore potential advantages of NWP.

Aim: The primary objective was to describe a single-center experience in the elective surgical management of Spigelian hernia, analyzing surgical approaches, perioperative morbidity, and long-term outcomes, with an emphasis on the recurrence rate.

Methods: A descriptive, retrospective, single-center study was conducted on adult patients (≥18 years) undergoing elective Spigelian hernia repair at the Santa Cristina University Hospital (Madrid) between June 2010 and May 2025. Emergency surgeries, ASA IV patients, and contaminated surgical fields were excluded. Demographic data, comorbidities, surgical technique (open approach), morbidity, length of hospital stay, and recurrence were analyzed.

Results: A total of 59 patients were included, with a mean age of 64 years (64.4% female) and a mean follow-up of 82 months (median 79). The most frequent presentation was pain associated with a mass (61%), and ASA II was the most common status (69.5%). Spinal plus local anesthesia was used in 62.7% of cases. The predominant approach was open repair with sublay mesh (91.5%), predominantly retromuscular (64.4% of sublay repairs). No intraoperative complications were reported. The postoperative seroma rate was 3.4%. Ambulatory surgery (same-day discharge) was performed in 50.8% of patients, and there were no readmissions. The recurrence rate was 3.4% (2 patients).

Conclusion: Elective open repair of Spigelian hernia using sublay mesh is a safe, effective, and durable technique. In our series, this approach was associated with minimal perioperative morbidity, no readmissions, and a very low recurrence rate, maintaining excellent long-term outcomes (median follow-up > 6 years).

Background: Parastomal hernia (PSH) is a debilitating long-term complication of stoma formation, often required as part of curative or palliative treatment for colorectal cancer. As a common downstream consequence of cancer surgery, PSH contributes significantly to chronic morbidity and impairs quality of life, yet practices surrounding its prevention and repair remain heterogeneous. Despite randomised evidence supporting prophylactic mesh, adoption is limited, and operative approaches to elective and emergency repair vary widely.

Methods: A cross-sectional survey of colorectal surgeons in Australia and New Zealand was conducted via the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) to assess current PSH management. The survey examined stoma creation practices, prophylactic and therapeutic mesh use, operative techniques, and responses to clinical vignettes. Subgroup analyses explored variation by surgeon seniority, practice setting, and country.

Results: Ninety-three surgeons responded (93/365, 25.5%), including 74/93 (79.6%) from Australia and 19/93 (20.4%) from New Zealand; 79/93 (84.9%) practised in metropolitan centres and 39/93 (41.9%) had > 15 years' experience. Routine prophylactic mesh use at stoma formation was reported by 11/93 (11.8%). For elective repair (n = 89), open access was preferred by 48/89 (53.9%) and Sugarbaker repair was the most common configuration (40/89, 44.9%). Technique selection differed by access: among surgeons favouring minimally invasive surgery (n = 41), 33/41 (80.5%) selected Sugarbaker, whereas those favouring open surgery (n = 48) more often selected keyhole (22/48, 45.8%) or retrorectus "sandwich" repair (18/48, 37.5%) (p < 0.00001). In the emergency small-bowel obstruction vignette, surgeons with > 15 years' experience more often favoured mesh use than those with ≤ 15 years (21/39, 53.8% vs 10/50, 20.0%; p = 0.0015). Overall operative volume was low, with 65/93 (69.9%) reporting 0-5 PSH repairs per year.

Conclusions: PSH prevention and repair across Australasia is marked by wide variability, low uptake of prophylactic mesh, and inconsistent technique selection. Operative approach strongly influenced repair configuration, and seniority appeared to drive emergency decision-making. Addressing PSH represents an important opportunity to reduce treatment-related morbidity in patients with pelvic malignancies undergoing stoma formation.

Purpose: Abdominal wall reconstruction in the presence of midline hernia (MH) and lateral hernia (LH) is a challenging procedure. The purpose of this study was to introduce surgical method combining the retromuscular sublay technique and component separation technique with mesh augmentation for the simultaneous repair of midline and lateral hernias.

Methods: Between January 2006 and January 2025, 67 consecutive patients who underwent abdominal wall reconstruction for combined MH and LH or parastomal hernia (PH) were retrospectively analysed. The abdominal wall was reconstructed using a combination of the retromuscular sublay technique and the component separation technique, followed by mesh reinforcement.

Results: Of 67 patients, 53 underwent reconstruction surgery for simultaneous MH and LH, and 14 patients underwent surgery for MH and PH. LH was incisional (after previous pararectal, oblique, subcostal, or "J" incisions) in 58.5%, at the site of stoma closure in 37.7%, and as a consequence of blunt trauma in 3.8%. The median total defect width was 15 cm (range, 11-18) for the entire cohort. The median operative time was 150 min. Overall morbidity was 17.9%. After a median follow-up period of 24 months (range, 1-58), recurrence developed in 2 (3%) patients and abdominal wall bulging in 1 (1.5%).

Conclusion: The combination of the retromuscular sublay technique, the component separation technique and mesh reinforcement is a safe and effective method for the simultaneous repair of MH and LH or PH.

Purpose: The management of hernia in immunocompromised patients remains a distinct surgical challenge, characterized by complex risk profiles, heightened susceptibility to infectious complications, and ambiguous consensus on optimal mesh selection and perioperative protocols. As the prevalence of immunosuppression continues to rise due to increasing organ transplant rates, autoimmune diseases, oncological therapies, and advanced age, understanding the nuances of mesh repair in this population is of paramount importance.

Methods: This review synthesizes current evidence on the safety, efficacy, and outcomes of hernia mesh repair in immunocompromised adults, traversing mesh materials, infection mitigation strategies, surgical techniques, recurrence and complication rates, patient-reported outcomes, cost-effectiveness, and future research imperatives.

Results: Advanced mesh materials-particularly long-acting resorbable meshes-show superior long-term durability but at elevated cost. The risk for mesh infection and recurrence is proportionate to immunosuppression burden, comorbidities, and operative field contamination. Notably, modern synthetic meshes, when coupled with stringent perioperative infection control and risk-mitigation strategies, offer durable repair with acceptable safety profiles, even in immunocompromised hosts.

Conclusion: There is insufficient evidence to support routine use of biologic mesh, except in select contaminated fields. Patient-reported metrics are increasingly recognized as essential for outcome assessment, though standardization remains incomplete. Cost-effectiveness favors synthetics unless contamination risks predominate or patient preference dictates otherwise. Gaps include inconsistent immunocompromised patient definitions, limited long-term data, and lack of tailored guidelines. Prospective, multicenter studies integrating real-world patient-reported and economic data are needed.