Hernia最新文献

Background: Formation of seroma/hematoma is one of the most common postoperative complications following laparoscopic inguinal hernia repair. This study aimed to identify risk factors associated with seroma/hematoma and construct a prediction model.

Methods: Elderly subjects undergoing laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP) were included in this study. The observation endpoint was set as the occurrence of seroma/hematoma within 3 months after TAPP surgery. Independent risk factors were identified through preliminary univariate screening and binary logistic regression analysis. These risk factors were then used to construct a nomogram predictive model using R software.

Results: A total of 330 patients were included in the analysis, of which 51 developed seroma/hematoma, resulting in an incidence rate of 15.5%. Obesity (OR: 3.54, 95%CI: 1.45-8.66, P = 0.006), antithrombotic drug use (OR: 2.73, 95%CI: 1.06-7.03, P = 0.037), C-reactive protein (CRP) ≥ 8 (OR: 2.72, 95%CI: 1.04-7.10, P = 0.041, albumin/fibrinogen ratio (AFR) < 7.85 (OR: 2.99, 95%CI: 1.28-7.00, P = 0.012), and lymphocyte/monocyte ratio (LMR) < 4.05 (OR: 12.62, 95%CI: 5.69-28.01, P < 0.001) were five independent risk factors for seroma/hematoma. The nomogram model has well predictive value for seroma/hematoma, with an AUC of 0.879.

Conclusions: The nomogram model based on obesity, antithrombotic drug, CRP, AFR, and LMR has a proved good predictive value and it has potential in clinical practice.

Background: Due to the proximity to bony structures and the complex anatomy of the three-layered lateral abdominal wall, the surgical treatment of lateral ventral hernias is technically demanding. With this study we would like to demonstrate how lateral abdominal wall hernias can be treated using new robotic surgical techniques with extraperitoneal mesh placement.

Objectives: The purpose of this study is to demonstrate that the application of the robot in minimally invasive treatment of lateral abdominal wall hernias is safe and efficient.

Materials and methods: A retrospective analysis of all patients who underwent robotically-assisted lateral ventral hernia repair surgery from June 2019 to December 2023 was performed.

Results: A total of 50 ventral hernias were operated robotically due to a lateral hernia in the study period. 45 patients had an incisional hernia and 5 patients a primary spighelian hernia. 27 patients had only lateral findings, whereas 23 patients had combined hernias with lateral and medial hernial defects. 18 patients were treated with a preperitoneal mesh (r-vTAPP). 31 patients required TAR to achieve complete fascial closure and sufficient mesh overlap (24 extraperitoneal approach r-eTAR/7 transperitonel approach r-TAR). One patient had to be converted intraoperatively from a planned preperitoneal mesh to an intraperitoneal mesh repair (r-IPOM). The median hernia defect area was 71 cm² (3-375 cm²). The median mesh size was 600 cm² (150-1290 cm²). The median mesh defect ratio (MDR) was 10 (2,33-133,33). Five postoperative complications were encountered (10%). Two reoperations (4%) were required.

Conclusion: The utilization of new robotic surgical techniques provides a safe minimally invasive treatment option even for complex lateral ventral hernias that previously posed difficulties in surgical management. The early postoperative results show promising outcomes.

Introduction: Hiatal hernia recurrence rates vary widely. The true causes of recurrences are not fully understood but likely multifactorial. Surgical approaches and techniques have evolved over time to try and reduce recurrence rates after hiatal hernia repair. Our objective is to provide a current review on the physiology of hiatal hernias and the importance of a composite crural repair on hiatal hernia recurrence rates; more specifically, for this review, a composite repair is defined as a repair requiring more than primary closure of the crura.

Methods: A recent review of the literature was conducted to identify studies reporting on hiatal hernia pathophysiology, stress, and tension, as well as the role of composite repair.

Results: There is a paucity of studies focusing on the pathophysiology of hiatal hernias and recurrence rates. Articles that report on the pathophysiology of the hiatus were found to have alterations of the extracellular matrix, collagen composition, changes in metalloproteinases (MMPs), and differences in genetic composition. The role of composite repair on reducing recurrence rates is not well studied.

Conclusions: Hiatal hernias remain a complex problem with no ideal surgical technique. It is likely that the pathophysiology of hiatal hernias is multifactorial, and more studies need to be done to better understand the potential underlying mechanisms for hiatal hernias so this may also further identify the ideal surgical repair.

Background: Occult inguinal hernias are inguinal hernias that are not felt on physical exam but can often be seen on imaging. Their diagnosis can be challenging, leading to unnecessary surgeon referrals, undue patient stress, and even unneeded surgery. The aim of this project was to develop recommendations for the diagnosis of occult inguinal hernias using a modified Delphi technique.

Methods: Iterative rounds of surveys were administered to an expert panel of surgeons and radiologists. Panelists were asked to rate potential hernia-related topics by levels of importance. Items with 80% agreement were included for further discussion. Panelists were asked to provide their opinion on each included subject. A virtual meeting was conducted to discuss areas without agreement and determine final recommendations.

Results: Three surgeons and five radiologists participated. There was strong agreement that dynamic ultrasound is a good first/confirmatory imaging choice. There was agreement that the radiology reports for studies assessing inguinal hernias should include hernia contents (80%) and hernia size (100%). Information that should be provided to the radiologist when ordering an imaging study include indication for study, patient symptoms, prior hernia surgery. Items that should be included in a radiology report include whether the presence of an inguinal hernia was assessed, hernia contents, size of defect, +/- hernia type.

Conclusions: This collaboration between surgeons and radiologists creates a diagnostic imaging pathway and standardizing imaging reporting which will be used to improve the diagnosis of occult inguinal hernias. Future studies testing these recommendations in a prospective study are warranted.

Purpose: Incisional hernias (IH) rates after diverting loop ileostomy reversal (DLI-R) have been reported up to 24%. We aimed to characterize the incidence rate and risk factors associated with DLI-R site IH formation within 1-year in a large patient cohort.

Methods: A retrospective review at a single quaternary referral center hospital of adult patients who underwent DLI-R over a 5-year period and abdominal computerized tomography (CT) imaging performed within 1-year for any indication postoperatively was conducted. All CTs scans were independently reviewed by staff surgeons to determine the presence of a fascial defect at the DLI-R site.

Results: 2,196 patients underwent DLI-R; of these, 569 (25.9%) underwent CT imaging for any indication. Mean patient age, 54.8 (± 14.9), BMI 27.6 kg/m². 87 (15%) patients had a parastomal hernia at time of DLI-R. After median follow-up of 10 months, 203 patients (35.7%) had IH at the DLI-R site. Age (p = 0.14), sex (p = 0.39), race (p = 0.75), and smoking status (p = 0.82) weren't associated with IH after DLI-R. Comorbidities weren't significantly associated with IH following DLI-R. In univariate analysis, increased BMI (p < 0.001), presence of a parastomal hernia (p = 0.008), and suture type (p = 0.01) were associated with IH development. On multivariate analysis, BMI remained significant, and polyglyconate compared to polydioxanone suture were associated with higher rates of IH (p < 0.001).

Conclusion: We observed that the rate of incisional hernias within 1-year of diverting ileostomy reversal was indeed common at 36%. Granted, a high percentage of the population was excluded due to heterogeneity in radiographic evaluation that could be mitigated in future prospective studies. Our study suggests that IH preventative strategies include weight loss for overweight and obese patients prior to DLI-R and that the optimal suture for DLI-R is polydioxanone.

Background: The incidence of incisional hernia (IH) after an open abdominal aortic aneurysm (AAA) repair can reach up to 35%, contributing to long-term morbidity. Individual studies have been limited in identifying modifiable risk factors for IH after an open AAA repair. This meta-analysis aims to review all the risk factors for IH after an open AAA repair.

Methods: We searched Cochrane Central, Embase, PubMed, MEDLINE, and Web of Science databases for original studies. Risk factors assessed were age, sex, comorbidities, surgical incision, blood loss, and surgical site infection (SSI). Data analysis was done using RStudio 4.1.2. We computed Relative Risk (RR) for dichotomous outcomes and Mean differences (MD) with 95% Confidence Interval (CI) for continuous outcomes. P-values less than 0.05 were considered statistically significant.

Results: Ten studies met the inclusion criteria among 1,795 screened articles. Among those ten studies, there were a total of 1,806 patients of which 341 patients developed IH. Older age (Mean 69.6-70.7 years, MD 1.39 years, CI [1.12-1.66], P < 0.01), midline vertical incision (RR 1.55, CI [1.06-2.25], P = 0.02) and increased intraoperative blood loss (MD 429.8 ml, CI [234.8- 624.8], P < 0.01) were associated with an increased incidence of IH. Surgical site infection (SSI) was noted as a risk factor for IH after open AAA repair (RR 2.36, CI [1.31-4.24], P = 0.004). No statistically significant association was found between the incidence of IH and sex (RR 1.0, CI [0.8-1.14], P = 0.98), smoking (RR 1.01, CI [0.93-1.09], P = 0.88), diabetes (RR 1.38, CI [0.85-2.25], P = 0.19), and chronic kidney disease (RR 1.55, CI [0.47-5.09], P = 0.46).

Conclusion: This meta-analysis shows that age, midline vertical incision, intraoperative blood loss, and SSI are risk factors for IH after open AAA repair.

Purpose: In laparoscopic inguinal hernia repair, it is thought that the mesh can be displaced more in the enhanced-view totally extraperitoneal (eTEP) technique. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in terms of mesh displacement and hernia recurrence.

Methods: Between December 2022 and April 2023, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups; eTEP group (n = 30) and TEP group (n = 30). There was without mesh fixation in both groups. Study was registered at http://Clinicaltrials.gov (NCT06070142). The mesh was marked with three radiopaque clips. Pelvic radiographs were performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP techniques in terms of mesh displacement without fixation in laparoscopic inguinal hernia.

Results: There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, length of hospital stay, hematoma, and seroma formation. The operation time was higher in the eTEP group and was statistically significant.

Conclusion: Without mesh fixation, the eTEP technique does not increase the risk of mesh displacement and recurrence. The eTEP technique can be safely applied without mesh fixation in laparoscopic inguinal hernia repairs.

Trial registration: ClinicalTrials number: NCT06070142.