Hernia最新文献

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).

Aim: More than one-third of inguinal hernias are asymptomatic, and performing surgery in the absence or presence of mild symptoms remains a point of concern for many surgeons. This study aims to evaluate whether watchful waiting (WW) is a viable management strategy for asymptomatic and mildly symptomatic inguinal hernias by comparing its outcomes to early surgical repair. To broaden the scope of existing evidence, we included both recent randomized controlled trials and observational studies.

Material and methods: PubMed, Cochrane Central, and EMBASE were searched for studies comparing early repair and WW in patients with asymptomatic or mildly symptomatic inguinal hernias. The primary outcomes assessed were the rate of crossover from WW to surgery, reasons for crossover, and the presence of pain in both groups. Secondary outcomes included quality of life (QoL) and hernia recurrence. A Kaplan-Meier failure function curve was constructed to estimate time from study enrollment to crossover.

Results: Among 619 screened studies, 12 met the inclusion criteria, covering 1,755 patients (748 (42.6%) in early surgical intervention and 1,007 [57.4%] in the WW). Among WW patients, 477 (27.1%) eventually crossed over to surgery, with crossover rates ranging from 6.1% (Patti 2014) to 75.4% (Chung 2011). Approximately 50% of WW patients required surgery within five years. The most reported reason for crossover was pain (65%), followed by impaired quality of life (16%), bowel-related symptoms such as incarceration or strangulation (8.5%), hernia volume progression (3%), and other or unspecified causes (7.5%). Pain was the most consistent patient-specific predictor of crossover to surgery.

Conclusion: WW appears to be a viable and safe approach with low complications rates for patients with asymptomatic inguinal hernias. However, long-term data show that approximately 50% of patients cross over to surgery within five years, and this proportion exceeds 96% by 12 years. Ultimately, the decision between WW and early surgical intervention should be guided by shared decision-making, considering patient values, symptom burden, comorbidities, and life expectancy.

Purpose: Pre-existing comorbidities may negatively impact surgical outcomes, yet risk profiles based on combinations of comorbidities are underutilized. We aimed to identify comorbidity clusters associated with adverse surgical outcomes after inguinal or ventral hernia repair.

Methods: We performed a retrospective cohort study using the ACS-NSQIP database (2016-2023). Adults undergoing elective inguinal or ventral hernia repair were identified using CPT and ICD-10 codes. Latent class analysis (LCA) identified subgroups of patients who shared similar patterns of comorbidities. Outcomes included postoperative complications, hospital length of stay, and 30-day mortality.

Results: Among 224,522 patients, LCA identified six profiles: no comorbidities, smoking, bleeding disorder or congestive heart failure (CHF), obesity with diabetes or smoking, obesity without diabetes or smoking, and hypertension. Compared with no comorbidities, risk of complications was higher in the smoking (OR 1.32, 95% CI 1.18-1.49), bleeding disorder or CHF (OR 1.68, 95% CI 1.23-2.29), obesity with diabetes or smoking (OR 1.41, 95% CI 1.25-1.58), obesity without diabetes or smoking (OR 1.17, 95% CI 1.06-1.29), and hypertension (OR 1.16, 95% CI 1.05-1.28) clusters. These clusters also had longer hospital stays compared to patients with no comorbidities. 30-day mortality was significantly increased in the "bleeding disorder or CHF" (OR 3.22, 95% CI 1.52-6.84) and hypertension (OR 1.66, 95% CI 1.09-2.54) clusters.

Conclusion: Distinct comorbidity clusters predict complications, prolonged hospitalization, and mortality following hernia repair. Incorporating comorbidity profiles into preoperative risk stratification may enhance surgical decision-making, allow targeted interventions, and improve outcomes in high-risk patients.

Purpose: The synthetic meshes were widely applied in laparoscopic repair of hiatal hernia. In contrast, there were few researches on the application of biological meshes and it's clinical effects needed to be further verified especially in the giant hiatal hernia. Our aim of this study was to assess the clinical outcomes and safety of biological versus synthetic meshes in a short-term comparative period.

Methods: This prospective cohort study of 174 patients with 87 patients in each group underwent laparoscopic repair of hiatal hernia from April 2022 to February 2024 in single‑center. The biological mesh group and the synthetic mesh group were respectively repaired with Small Intestinal Submucosa (SIS) mesh and anti-adhesion polypropylene mesh for crura reinforcement. The general baseline characteristics, perioperative data, complications, recurrence rate, symptom and quality of life improvement data (the Visual Analog Scale, VAS and the Short Form 36 Health Survey, SF-36), satisfaction were collected. Follow-up data were collected at 6 and 12 months postoperatively.

Results: In comparison between the two groups, no significant differences were observed in the general baseline characteristics including sex, age, BMI, chronic disease, preoperative PPI use, preoperative anaemia (P > 0.05) and perioperative data including operation times, blooding loss, defect length, defect width and mesh-related reactions (extensive perimesh fluid collection and postoperative fever) (P > 0.05). The postoperative hospital stay of the biological group was longer than the synthetic group (4.5 ± 1.6vs. 4.1 ± 1.1; P = 0.111) with no statistical difference. There was no mortality and mesh-related complications such as dysphagia, mesh infection, esophageal erosion, esophageal perforation in each group. Both groups demonstrated similar and significant improvement in quality of life scores and symptoms scores with high satisfaction at 6 and 12 months postoperatively (P > 0.05). The recurrence rate was 0% in the biological mesh group and 1.1% in the synthetic mesh group at 6 months (P = 0.316). At 12 months, the recurrence rate was 1.1% in each group (P = 1.000). All recurrent cases were diagnosed as type IV hiatal hernia preoperatively.

Conclusions: Biological and synthetic meshes demonstrated similar and satisfactory results in clinical effect and improvement of quality of life with low recurrence and complication rates in laparoscopic hiatal hernia repair. The biological mesh is effective and safe in the repair of giant hiatal hernia. Compared with synthetic meshes, the application of biological meshes does not increase the postoperative hospital stay due to the mesh-related reactions in a short-term comparative period.

Objective: To evaluate the efficacy and safety of different methods of managing the distal hernia sac in preventing seroma after laparoscopic transabdominal preperitoneal repair (TAPP) for large indirect inguinal hernias.

Methods: A retrospective analysis was conducted on 163 male patients with unilateral large indirect inguinal hernias (hernia sac diameter > 5 cm) who underwent TAPP at the Department of Gastrointestinal Surgery, Fuling Hospital of Chongqing University between January 2020 and January 2025. Based on the method of hernia sac management, patients were divided into three groups: Group A (n = 38) underwent complete dissection of the hernia sac; Group B (n = 61) underwent transection and abandonment of the distal sac; Group C (n = 64) underwent midline transection of the lateral hernia sac combined with lateral fixation of the residual stump. Perioperative indicators, postoperative VAS scores, and complication rates were compared among the groups.

Results: All 163 patients successfully completed the surgery. Operative time was significantly longer in Group A (94.16 ± 21.93 min) compared to Groups B (80.59 ± 27.00 min) and C (93.97 ± 23.49 min) (P = 0.027), whereas no significant difference was detected between Groups B and C. The time required for hernia sac management also differed significantly across groups (P < 0.001), being longest in Group A, followed by Group C, and shortest in Group B. In terms of hospital stay, Group B (6 [5, 7] days) stayed significantly longer than both Group A and Group C (both 5 [4, 7] days) (P = 0.005). The incidence of seroma was significantly higher in Group B (18.03%) than in Group A (5.26%) and Group C (4.69%) (P = 0.035). Multivariable logistic regression further identified the surgical technique used in Group B as an independent risk factor for seroma (aOR: 5.47, 95% CI: 1.35-22.13, P = 0.017). The incidences of scrotal hematoma and ischemic orchitis were significantly higher in Group A than in the other two groups (P = 0.012 for both). There were no significant differences among the three groups in postoperative VAS scores, intraoperative blood loss, urinary retention, infection, recurrence, or chronic pain rates.

Conclusion: In this study, midline transection of the lateral hernia sac combined with lateral stump fixation was associated with a lower incidence of seroma after TAPP for large indirect inguinal hernias, without a significant increase in the risks of postoperative pain, scrotal hematoma, ischemic orchitis, infection, recurrence, or other complications.