Hernia最新文献

Background: Impairments in abdominal wall function are common in patients with hernias, with negative effects on their quality of life, often requiring surgical repair. Despite advances in repair techniques, there is no consistent standard for assessing abdominal wall function throughout the peri-operative period, limiting comparability between treatments. The aim of this scoping review was to identify and appraise all the available assessments of abdominal wall function reported in the literature, with a focus on the assessment methods and tools used.

Objectives: To identify and review the assessment methods and tools used to measure abdominal wall function.

Eligibility criteria: All studies investigating abdominal wall function through any type of assessment were included. There was no restriction on the year of publication.

Source of evidence: A literature search was performed of the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases in June 2025.

Charting methods: Data was extracted independently by two reviewers. Extracted data included assessment tools and functional domains.

Results: 18 studies were included, where the majority (88.9%) of them focused on the assessment of abdominal muscle strength. Other aspects of abdominal wall function, such as trunk mobility, core stability, and postural control, were also reported but less frequently. There was considerable heterogeneity in how and when abdominal wall function was assessed and defined.

Conclusion: This scoping review identified substantial variation in assessments of abdominal wall function. The evaluation of abdominal muscle strength remains dominant, but there is inconsistency regarding the tools and tests used, including isokinetic or isometric dynamometers, surface electromyography (sEMG), and clinical tests such as double leg lowering and trunk raising tests, assessed at different postoperative timepoints. No comprehensive or standardized method currently exists to evaluate abdominal wall function across domains and timepoints, underscoring a critical gap in clinical and research practice. Future research needs to develop or modify existing assessment methods to reflect abdominal wall function more holistically.

Purpose: There is a growing interest in developing new animal models to better understand the postoperative response of hernia meshes, which are key to improving device evaluation and clinical outcomes. This study presents an animal program using a porcine model to evaluate mesh response at the early postoperative period through in vivo imaging and and ex vivo pressure-based bench testing, comparing a lightweight flatsheet (LWF), a heavyweight flatsheet (HWF) and a self-fixating mesh (SFM).

Methods: Partially radiopaque meshes were implanted in vivo in twelve pigs. Two surgical models were compared: with and without open abdominal defect. CT scans were performed immediately and one week after surgery to assess the evolution of the mesh shape, position and defect size. Ex vivo porcine AW tissues were tested for mesh dislocation under repeated 250 mmHg cyclic pressure.

Results: In vivo, all meshes performed similarly on intact abdominal walls, while the SFM mesh demonstrated superior performance compared to LWF and HWF when implanted over an open defect without any fixation. SFM was associated with minimal adverse effects, whereas LWF and HWF frequently led to poor integration, seroma formation and mesh dislocation into the defect. Ex vivo pressure testing exhibited similar trends: SFM provided better repair protection, while LWF-and to a lesser extent HWF-exhibited progressive migration/dislocation into the defect and defect enlargement under pressure, which reduced mesh overlap and ultimately resulted in total mesh dislocation.

Conclusion: This preclinical program could serve as a standardized and reproducible framework, enabling comparison of new mesh designs based on their sensitivity to known modes of failure.

Background: Robotic transabdominal preperitoneal (r-TAPP) inguinal hernia repair is increasingly performed, but its economic value relative to laparoscopic TAPP (l-TAPP) remains uncertain, particularly in publicly funded health systems.

Methods: A monthly state-transition (Markov) model was developed over a 24-month period from the perspective of the Italian National Health Service (SSN). A 90-day hospital/provider perspective was explored in scenario analyses. Costs were valued in 2023 euros, combining micro-costing data from a Spanish comparative study adjusted with OECD purchasing-power parities and Eurostat inflation indices, alongside Italian tariffs. Transition probabilities were derived from randomized trials and meta-analyses. Health-state utilities were obtained from EQ-5D studies in hernia populations and applied to model states. Deterministic one-way and probabilistic sensitivity analyses (10,000 iterations) were performed. Outcomes included incremental costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and probabilities of cost-effectiveness at willingness-to-pay thresholds of €20,000-30,000 per QALY.

Results: In the SSN base case, r-TAPP generated an incremental cost of €2,224 and a gain of 0.05 QALYs versus l-TAPP, yielding an ICER of €44,480/QALY. At a €30,000/QALY threshold, the probability of cost-effectiveness was less than 25%. Scenario analyses incorporating Italian inputs or regional tariffs further reduced the cost-effectiveness. Exploratory model-based scenario analyses (bilateral repair, elevated BMI) also yielded ICERs ≥ €30,000/QALY, confirming limited probability of cost-effectiveness. Recurrence and reoperation rates were assumed equal between r-TAPP and l-TAPP, consistent with current evidence; however, potential differences over longer horizons could alter cost-effectiveness estimates.

Conclusions: r-TAPP is associated with substantially higher costs and only marginal health gains compared with l-TAPP. The incremental QALY gain was small and not clinically meaningful, resulting in a probability of cost-effectiveness below 25% at a €30,000/QALY threshold. Routine adoption cannot be justified under current cost and reimbursement conditions, and its role should be confined to structured training programs or prospective research protocols.

Background: Incisional flank hernias pose a particular challenge due to scarred, retracted fascial edges and complex regional anatomy. This study evaluates a robotic-assisted technique employing progressive intermittent intracorporeal fascial traction (Vicryl 0 sliding-knot) combined with barbed-suture augmentation (STRATAFIX™ Symmetric PDS 0) in large-volume defects.

Methods: Between June 2023 and January 2025, 13 patients with symptomatic incisional flank hernias underwent repair with the da Vinci X^® system. A macroporous polypropylene mesh was implanted. Patients were followed up at 1-, 3-, and 6-months including ultrasound, VAS pain scoring, and recurrence screening.

Results: Median total operative time was 167 min (IQR 117-193.5), console time 141 min (IQR 104.5-176.5). The median defect size was 138.75 cm² [IQR 55.5-249]. Meshes with a median size of 433 cm² [315-572.5] and a mesh-to-defect ratio of > 3:1 were implanted. Pain scores remained stable at median VAS 2/10 on postoperative days 1-3. One patient developed seroma (Clavien-Dindo I); no Clavien-Dindo ≥ II complications occurred. No hernia recurrences were observed till the six months follow-up. Median length of stay was 2 days (IQR 2-3).

Conclusion: Progressive intracorporeal fascial traction with sliding-knot technique and barbed-suture reinforcement allows safe, tension-reduced repair of large incisional flank hernias, resulting in low pain levels, brief hospitalization, and no early recurrences. Longer-term, comparative studies are warranted.

Introduction: There is an increasing adoption of e-TEP technique for inguinal hernia repair. However, there remains a lack of clarity regarding the criteria for selecting this technique and whether it leads to better clinical outcomes compared to standard laparoscopic methods. To address this gap, the present study analyzed data from the Indian Hernia Collaborative-a multicenter initiative of the Hernia Society of India (HSI) launched in 2022. The study aimed to assess the patterns of case selection and outcomes associated with e-TEP in comparison to TEP and TAPP.

Methods: The datasets were collected from 26 centres using a pre-designed Excel sheet. Each dataset included one-year follow-up data for all patients. A comparative analysis was conducted for patients who underwent laparoscopic groin hernia repair using one of three techniques: enhanced-view totally extraperitoneal (eTEP), transabdominal preperitoneal (TAPP), or totally extraperitoneal (TEP) repair.

Results: Of the 1,510 patients, 992 underwent laparoscopic groin hernia repair and the rest were open surgeries. Among them, 537 patients had bilateral repairs, resulting in a total of 1,529 individual laparoscopic procedures. The distribution of techniques was as follows: TAPP in 489 (49.3%), TEP in 489 (27.9%), and enhanced-view eTEP in 226 (22.8%) of cases. TAPP was more commonly selected for irreducible hernias. The eTEP technique was more often utilized in larger hernias (W3), compared to TEP. Mesh fixation was significantly more frequent in the TAPP group (97.7%) compared to the eTEP (86.7%) and TEP (38.2%) groups. Plication of the hernia sac was commonly performed in TAPP (20.2%), followed by TEP (5.85%) and e-TEP (2.38%), with the differences being statistically significant (p < 0.001). However, the operative duration was significantly longer for eTEP (87.3 min) and TAPP (94.1 min) than for TEP (70.2 min). Seroma, surgical site infection, hematoma, postoperative pain and recurrence rates were comparable across all three techniques.

Conclusion: In India, eTEP has seen a rapid rise in adoption amongst TEP surgeons and is increasingly being utilized for larger and more complex groin hernia repairs, however, there is no difference in short-term outcomes between the three procedures.

Objective: To evaluate the safety, efficacy, and long-term outcomes of concomitant laparoscopic bariatric surgery and ventral hernia repair in obese patients. Obesity and ventral hernia frequently coexist, often presenting a surgical dilemma. Historically, concerns over mesh infections, extended operative time, and increased morbidity have led to a preference for staged procedures. However, with advancements in laparoscopic techniques and increasing evidence supporting mesh placement in clean-contaminated fields, the concomitant approach has gained acceptance. High-quality data from large-volume centers remain limited till now.

Method: This retrospective study was conducted at a tertiary care center between January 2003 and December 2023. A total of 353 patients underwent simultaneous bariatric surgery-either laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), or mini-gastric bypass (MGB-OAGB)-with ventral hernia repair using intraperitoneal onlay mesh (IPOM), eTEP-Ventral RS, or eTEP-TAR techniques. The Primary objective of the study was to assess the complication and recurrence rates. Secondary objective included operative time, hospital stay, and postoperative recovery.

Results: Of the 353 patients, 224 underwent LSG, 74 LRYGB, and 55 MGB-OAGB. IPOM was used in 90% of cases. The overall complication rate was low, with seroma (2.3%), ileus (2.6%), hematoma (1.1%) and Surgical site occurrences (SSO) (3.4%) being the most common. No mesh infections or anastomotic leaks were observed. Mean operative time ranged from 124 to 167 min, and average hospital stay was 3.1 ± 1.1 days. At one-year follow-up in 268 patients (80%), hernia recurrence was 0.6%.

Conclusions: Concomitant laparoscopic bariatric surgery with hernia repair is a safe and effective option in appropriately selected patients, with excellent outcomes and minimal complications.

Background: Absorbable synthetic meshes have gained increasing acceptance for crural reinforcement during hiatus hernia (HH) repair because their safety profile and the potential of reducing recurrence rates. Bio-A^® (Gore Medical, Newark, DE, USA) and Phasix-ST^® (C.R. Bard, Inc./Davol, Inc., Warwick, RI, USA) are the most commonly used meshes. While previous single-arm studies have been published, there are no articles reporting the comparison between Phasix-ST^® vs. Bio-A^®.

Aim: Compare safety, efficacy, recurrence rates, and quality of life after laparoscopic HH repair and cruroplasty reinforced with either Bio-A^® or Phasix-ST^® mesh.

Methods: Retrospective multicenter study (September 2011- December 2024). All patients that underwent minimally invasive HH repair with Phasix-ST^® or Bio-A^® reinforced cruroplasty and Toupet fundoplication were included.

Results: Overall, 271 patients were included. Bio-A^® reinforcement was utilized in 46.8% of patients. The median follow-up time was 94 (IQR 21) months for Bio-A^® and 51 (IQR 17) months for Phasix-ST^® mesh. Hernia recurrence was diagnosed in 10.1% of patients with similar rates for Phasix-ST^® vs. Bio-A^® (7.8% vs. 12.6%; p = 0.28). The regression analysis showed that Phasix-ST^® (HR 0.66), 'keyhole' configuration (HR 0.81), hernia type III-IV (HR 1.38), and recurrent HH (HR 1.27) were not independent predictor or protective factors for recurrence. The 55-month recurrence free probability for Bio-A^® vs. Phasix-ST^® was comparable (86.2% vs. 91.8%; p = 0.132).

Conclusions: This study shows that Bio-A^® and Phasix-ST^® are equally safe for crural reinforcement during HH repair. Due to the longer absorption rate, Phasix ST^® might presumably confer enhanced hiatal protection early in the course of the follow-up.

Rectus diastasis repair can be approached in many different ways from robotic to open. However, a large part of the transformation a plastic surgeon can offer a patient who is seeking a diastasis repair is to combine the rectus diastasis repair with body contouring procedures. Patients with excess soft tissues, lax skin or lipodystrophy will benefit from a concomitant body contouring procedure, most commonly in some form of abdominoplasty. Minimally invasive options can be offered; however, patient selection is crucial for the optimal and expected outcome. For patients with a small amount of excess skin, liposuction or other-energy based procedures can be offered to enhance results. Patients should be properly educated on what surgery they are getting and the expected results that can be obtained.