What is the preferred mesh placement in primary ventral hernia repair? An international survey of 442 surgeons.

IF 2.4 2区医学 Q1 SURGERY

Hernia Pub Date : 2025-09-09 DOI:10.1007/s10029-025-03429-1

Usamah Ahmed, Jacob Rosenberg, Sarfaraz Jalil Baig, Sujith Wijerathne, Wah Yang, Shuqing Li, Jason Joe Baker

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引用次数: 0

Abstract

Purpose: Primary ventral hernia repair is a common elective procedure; however, mesh placement practices vary widely, and there is limited evidence to guide optimal placement. This international study examined surgeons' preferences and considerations regarding mesh placement in elective primary ventral hernia repair.

Methods: We conducted an international cross-sectional survey targeting surgeons experienced in primary ventral hernia repair. The survey was distributed through hernia societies and social media platforms. It included 31 questions addressing surgeon demographics and their beliefs on various mesh placements. Data were collected using REDCap, Google Forms, and Questionstar.

Results: A total of 442 surgeons participated, with the majority being specialist surgeons (96%) who had performed at least 100 repairs (82%). Inlay was the least familiar mesh technique (26%). For hernia defects < 1 cm, preperitoneal (28%) and suture-only repair (27%) were considered to yield the best overall outcomes. For defects ≥ 1 to ≤ 4 cm, preperitoneal and retromuscular techniques were equally favored (34%), whereas retromuscular was regarded as the best option for larger defects (> 4 to 9 cm; 68%). Laparoscopic and robotic-assisted approaches were increasingly preferred for larger defect sizes. Hernia defect size (93%), surgical history (90%), and obesity (80%) were the most common factors influencing the choice of mesh placement.

Conclusion: Preperitoneal and suture-only repairs were most commonly selected for hernia defects < 1 cm, while preperitoneal and retromuscular placements were equally favored for defects ≥ 1 to ≤ 4 cm. For defects > 4 to 9 cm, retromuscular placement was selected by most surgeons. As defect width increased, laparoscopic and robot-assisted approaches gained preference. Key factors influencing decisions included hernia defect size, surgical history, and obesity. The lack of strong supporting evidence highlights the need for further high-quality research.

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初次腹疝修补时，补片的首选位置是什么？一项对442名外科医生的国际调查。

目的：原发性腹疝修补术是一种常见的选择性手术；然而，网状物放置实践差异很大，指导最佳放置的证据有限。这项国际研究调查了外科医生在选择性原发性腹疝修补术中对补片放置的偏好和考虑。方法：我们进行了一项针对具有原发性腹疝修补经验的外科医生的国际横断面调查。这项调查是通过疝气协会和社交媒体平台发布的。它包括31个问题，涉及外科医生的人口统计数据和他们对各种网状物放置的看法。使用REDCap、谷歌Forms和Questionstar收集数据。结果：共有442名外科医生参与，其中大多数是专科外科医生（96%），至少进行过100次修复（82%）。嵌体是最不常见的网状技术（26%）。对于疝缺损4 ~ 9 cm；68%)。腹腔镜和机器人辅助方法越来越倾向于较大的缺陷尺寸。疝缺损大小（93%）、手术史（90%）和肥胖（80%）是影响补片放置选择的最常见因素。结论：4 ~ 9 cm疝缺损多选择腹膜前修补和单线修补，肌后修补多选择腹膜后修补。随着缺陷宽度的增加，腹腔镜和机器人辅助的方法得到了优先考虑。影响决定的关键因素包括疝缺损大小、手术史和肥胖。由于缺乏强有力的支持证据，因此需要进一步开展高质量的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.