Hernia最新文献

Background: Incisional and non-incisional ventral hernias are common and important causes of symptoms, functional restriction, and complications, with significant potential to impact upon quality of life. The goals of hernia repair are to treat, prevent or improve these. However, outcomes of surgery remain relatively poor with significant gaps within the evidence base, which may be due to inconsistent use of outcome measures. The aim of this study was to appraise outcome reporting in the recent literature of randomized controlled trials (RCTs).

Objectives: This scoping review aimed to map and categorize the outcome measures reported in RCTs of incisional and non-incisional ventral hernia repair.

Eligibility criteria: All RCTs assessing any intervention related to incisional, primary, or recurrent ventral hernia repair between2015 and 2025 were included.

Source of evidence: A literature search was performed of the PubMed, EMBASE (1974 to present), and Cochrane Central Register of Controlled Trials databases in November March 2025.

Charting methods: Data was extracted independently by two reviewers. All outcomes reported by the included studies were identified and recorded.

Results: 118 RCTs were included. Their outcomes were mapped into five main broad categories. The commonest outcomes used were short-term operative complications (72.9%), hernia recurrence (59.3%), pain (57.6%), and quality of life (33.9%). Patient-reported outcomes were measured in 78 (66.1%) randomized controlled trials, of which 15 assessment tools were identified; 11 were generic, and 4were hernia-specific. There was considerable heterogeneity in how and when these endpoints were assessed and defined.

Conclusion: This scoping review found considerable differences in outcome reporting in contemporary RCTs of incisional and non-incisional ventral hernia. These have significant implications for translating evidence into practice, and its synthesis, and support the need for a core outcome set in this field. However, we identified areas such as abdominal wall function which are infrequently reported and require consideration.

Purpose: Retromuscular ventral hernia repair (RVHR) is a well-established and increasingly popular technique for mesh placement, offering favorable recurrence and complication rates. However, the role of mesh fixation in RVHR remains unclear, as some have questioned its effect on reducing recurrence and could potentially increase postoperative morbidity. We performed a systematic review and meta-analysis to compare outcomes of RVHR with and without mesh fixation.

Methodology: PubMed, EMBASE, and Cochrane Library were searched through July 2025. Eligible studies included adult patients undergoing open RVHR with or without fixation. Primary outcomes were hernia recurrence and postoperative pain; secondary outcomes included hematoma, seroma, surgical site infection (SSI), reoperation, operative time, length of stay (LOS), and quality of life. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects models were used, and heterogeneity was quantified using the I2 statistic.

Results: Six studies (15,106 patients; 3,994 without fixation) met inclusion criteria: two randomized controlled trials and four observational cohorts, including one registry study. Recurrence did not differ between fixation and non-fixation (OR 1.1, 95% CI 0.91-1.34; I2 = 0%). Fixation was associated with significantly worse quality-of-life scores (MD -12.71, 95% CI -16.48 to -8.93; p < 0.001; I2 = 0%) and higher hematoma risk (OR 5.18, 95% CI 1.18-22.68; p = 0.03; I2 = 0%). No significant differences were found for pain, SSI, seroma, reoperation, LOS, or operative time.

Conclusion: Our systematic review and meta-analysis identified no difference in recurrence, pain, SSI, or long-term outcomes between mesh fixation and non-fixation in RVHR. However, fixation was associated with significantly worse quality-of-life scores and a higher risk of hematoma. These findings suggest a selective rather than routine use of mesh fixation in RVHR.

Introduction: Parastomal hernias (PSHs) significantly impact the quality of life and pose risks including obstruction and stoma dysfunction. Minimally invasive approaches, particularly robotic surgery, are increasingly employed for elective PSH repairs, yet comparative outcomes remain insufficiently studied. This study evaluated short-term outcomes comparing robotic and open PSH repairs.

Methods: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients undergoing elective open, laparoscopic, or robotic PSH repairs were identified. Propensity score matching was used to balance baseline characteristics, and multivariate logistic regression identified independent predictors of complications.

Results: Of 1,322 patients, 734 (55.5%) underwent open repair, 408 (30.9%) robotic, and 180 (13.6%) laparoscopic. After matching 808 patients (404 robotic, 404 open), robotic repair significantly reduced overall complications (50 patients, 12.4% vs. 101 patients, 25.0%; p < 0.001), surgical complications (22 patients, 5.4% vs. 45 patients, 11.1%; p = 0.003), medical complications (36 patients, 8.9% vs. 66 patients, 16.3%; p = 0.001), superficial surgical site infections (8 patients, 2.0% vs. 26 patients, 6.4%; p = 0.002), and bleeding requiring transfusion (2 patients, 0.5% vs. 13 patients, 3.2%; p = 0.004). Robotic surgery also reduced length of stay (3.26 days vs. 6.08 days; p < 0.001). Multivariate analysis confirmed robotic technique as an independent protective factor against postoperative complications (OR: 0.414; p < 0.001). (OR: 0.414; p < 0.001).

Conclusion: Robotic-assisted PSH repair significantly reduces perioperative morbidity, complication rates, and hospital length of stay compared to open surgery. These results support robotic approaches as preferable for elective PSH repair.

Aim: The aim of this study was to explore patients' experiences of participation in a preoptimisation programme prior to ventral hernia repair, focusing on the programme's feasibility and patient-perceived potential.

Introduction: Preoptimisation of modifiable risk factors has received growing attention, but little is known about ventral hernia patients' perspectives on such programmes. Understanding patient motivation and perceived barriers is critical for designing effective interventions.

Method: Eight ventral hernia patients participated in a home-based preoptimisation programme lasting at least three weeks. Focus group interviews were conducted and analysed using reflexive thematic analysis.

Results: Participants generally perceived the preoptimisation programme positively. Clear and structured advice was valued, with participants appreciating straightforward instructions on physical activity and lifestyle change. Reported barriers included everyday life circumstances, orthopaedic comorbidities, and in some cases the hernia itself. Patients described perceived positive health effects, including improved fitness, weight loss, and better diabetes control. No adverse effects were raised during the interviews.

Conclusion: This is, to our knowledge, the first qualitative study of pre-optimisation programmes in ventral hernia surgery. As an exploratory, hypothesis-generating study, its findings are shaped by sample size and setting but provide novel insights that complement quantitative research by highlighting patient perspectives. Pre-optimisation programmes appear feasible and meaningful to ventral hernia patients, particularly when supported by clear guidance, structured follow-up, and surgeon involvement. The findings are discussed in the light of Self-Determination Theory, which emphasises internalisation of motivation through autonomy, competence, and relatedness.

Purpose: Incisional hernia is a common postoperative complication following abdominal surgery. Despite the use of synthetic meshes, recurrence rates remain high. This study aimed to develop and evaluate a biodegradable, aligned microfibrous scaffold to support wound healing and strengthen abdominal wall repair.

Methods: Scaffolds were fabricated from poly(ε-caprolactone) (PCL) using a controlled fiber-drawing technique to produce highly aligned microfibers with reproducible thickness and architecture. Their biocompatibility was examined in vitro using fibroblasts through adhesion and proliferation assays. For in vivo evaluation, the scaffolds were implanted over standardized abdominal wall incisions in rabbits. After six weeks, the regenerated tissue was harvested for mechanical testing to determine tensile strength and elasticity, while histological and immunohistochemical analyses assessed collagen type I deposition and neovascularization within the scaffold area.

Results: The aligned PCL scaffold promoted strong cell attachment and proliferation in vitro. In vivo, its application significantly increased tensile modulus compared with control wounds. Histological analysis revealed denser and more organized collagen deposition and a higher microvessel density in the scaffold-treated group, indicating enhanced tissue remodeling and vascular integration.

Conclusion: The aligned PCL microfibrous scaffold improved the mechanical and biological quality of the abdominal wall healing in vivo. These results suggest its potential for reducing the formation of incisional hernias and are suitable for further testing leading to use in clinical practice.

Purpose: During the COVID-19 pandemic, digital encounters became a crucial means of maintaining access to care amid restrictions on in-person interactions. As these limitations ease, it is essential to evaluate the outcomes of telehealth-based consultations. Before the pandemic, telehealth was predominantly used in postoperative care for surgical populations. This study examines the safety and efficacy of telehealth-based consultations compared to traditional in-person preoperative evaluations for small ventral hernia repair, contributing to the understanding of how telemedicine can be effectively integrated into surgical practices.

Methods: We utilized a prospectively maintained single-center database from a tertiary referral hospital with a specialized hernia and abdominal wall reconstruction team to compare preoperative, intraoperative, and postoperative variables between ventral hernia patients who received telehealth-based (phone or video) consultations and those who had any in-person clinic evaluation.

Results: A total of 187 patients with small (< 4 cm) ventral hernias were evaluated, with 42 (22%) being evaluated entirely through telemedicine-based consultations prior to their surgery. There were comparable post-operative outcomes for patients evaluated entirely virtually preoperative compared to those evaluated with at least one traditional in-person evaluation. In both cohorts, 52% of patients followed up at one-year through our hernia surveillance program. The unanticipated recurrence rates observed were 0% for digital pre-operative patients, and 2.01% for patients evaluated in person pre-operatively (p = 1).

Conclusions: Based on the data presented here, virtual preoperative encounters are as safe and effective as traditional in-person evaluations for patients with small ventral hernias.

Background: Incisional hernia (IH) is a significant complication that occurs after midline laparotomy and is associated with high morbidity and economic impacts. A fundamental goal of preventing IH is to determine which patients are considered low- or high-risk, as modifications in prevention techniques have been justified in high-risk patients.

Aim: of this study was to externally validate the IHXGBoost-P model to assess its accuracy, generalizability, and clinical applicability in an independent cohort.

Methods: A prospective cohort study was conducted in a tertiary hospital in Mexico (March 2021-December 2022) to externally validate the IHXGBoost-P model. Patients older than 18 years who underwent midline laparotomy and have a minimum follow-up of 24 months were included. The performance of the model was evaluated via area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, precision, specificity and calibration metrics.

Results: Of the 438 patients analyzed, 62 (14.1%) developed IH. The model demonstrated good discriminative capacity (Accuracy: 0.94 ± 0.015) and calibration (Brier score: 0.051). Key predictors included the risk of surgical site infection (odds ratio (OR): 3.01, 95% CI: 2.32-3.91), previous surgery, and body mass index (BMI). The specificity (0.97 ± 0.013) was determined to be high and useful for identifying lowrisk patients.

Conclusions: The IHXGBoost-P model is a reliable tool for predicting the risk of IH, with robust performance being observed in external validation. Its integration into clinical practice through a web application could optimize surgical decision-making to prevent IH.

Purpose: Inguinal hernias are commonly encountered during robotic-assisted radical prostatectomy (RARP), either preoperatively or intraoperatively. Performing concurrent inguinal hernia repair (IHR) at the time of RARP may prevent the morbidity, cost, and inconvenience associated with a second operation. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of concurrent IHR during RARP compared with RARP alone.

Methods: This study followed PRISMA guidelines and was prospectively registered with PROSPERO (CRD42025646245). Comprehensive searches of PubMed, EMBASE, and Cochrane CENTRAL were conducted to identify studies comparing outcomes of RARP with and without concurrent IHR. Primary outcomes included operative time, length of hospital stay, blood loss, and postoperative complications. A proportional meta-analysis was performed using a random-effects model, and heterogeneity was assessed using the I² statistic.

Results: Twenty studies comprising 1,402 patients who underwent concurrent IHR and 20,405 patients who underwent RARP alone were included. Concurrent IHR was associated with a statistically significant increase in operative time (mean difference 30.45 min; 95% CI 13.71-77.38) but showed no significant differences in postoperative complications, blood loss, or hospital stay. The pooled hernia recurrence rate was low (mean 1.9%), and Clavien-Dindo I-III complication rates were comparable between groups.

Conclusion: Concurrent IHR during RARP may be feasible, with perioperative outcomes broadly comparable to RARP alone. Concurrent repair may be considered in selected patients and experienced centres however given study heterogeneity and the predominance of retrospective evidence, these findings should be interpreted cautiously.

Trial registration: The trial was prospectively registered on PROSPERO on 03/02/2025 under ID: CRD42025646245.