Hernia最新文献

{"title":"Preoperative weight loss for open abdominal wall reconstruction: study protocol for a randomized controlled trial.","authors":"Daphne Remulla, Kimberly S Miles, Alvaro Carvalho, Sara M Maskal, W Scott Butsch, Lucas R Beffa, Clayton C Petro, David M Krpata, Ajita S Prabhu, Michael J Rosen, Benjamin T Miller","doi":"10.1007/s10029-025-03375-y","DOIUrl":"https://doi.org/10.1007/s10029-025-03375-y","url":null,"abstract":"<p><strong>Background: </strong>Obesity is widely recognized as a risk factor for poor outcomes following ventral hernia repair. This belief has led many surgeons to implement arbitrary body mass index (BMI) cutoffs, typically 35-40 kg/m<sup>2</sup>, before offering elective hernia repair. These practices are based on low-quality evidence and create significant challenges for patients with symptomatic hernias who lack access to metabolic and bariatric surgery or obesity medications. We aim to compare medical weight loss followed by surgery versus upfront surgery in patients with severe obesity undergoing ventral hernia repair.</p><p><strong>Methods: </strong>This is a registry-based, parallel, randomized controlled trial with 1:1 allocation. A total of 258 patients with a BMI 40-55 kg/m<sup>2</sup> who are planning to undergo open retromuscular ventral hernia repair are randomized to a six-month preoperative medical weight loss program followed by surgery or upfront surgery. The medical weight loss program is conducted by a nurse practitioner trained in obesity medicine. The primary hypothesis is that abdominal wall-specific quality of life, as measured by Hernia-Related Quality-of-Life Survey (HerQLes) summary scores at one year, for the upfront abdominal wall reconstruction intervention will be non-inferior compared to a preoperative medical weight loss program followed by surgery. Secondary outcomes include hernia recurrence rates at one-year, wound morbidity at 30 days and one year, and rates of emergency hernia repair, readmissions, complications, and reoperations between groups. Patient-reported outcomes include quality of life and pain scores at baseline, 30 days, and after completing the standard medical weight loss program. Weight-related outcomes include changes in weight from enrollment through one-year follow-up, rate of achievement of weight loss goals, and the association of weight loss and program completion on postoperative outcomes. Lastly, we will evaluate cost-effectiveness using quality-adjusted life years and incremental cost-effectiveness ratios.</p><p><strong>Discussion: </strong>Preoperative weight loss offers potential benefits for patients with obesity undergoing hernia repair including decreased wound morbidity, reduced technical difficulty, and potentially lower recurrence rates. However, disadvantages include prolonged diminished quality of life, risk of emergent hernia repair during the weight loss period, limited access to effective weight loss interventions, and challenges with adherence to weight loss protocols and long-term weight maintenance. This randomized controlled trial will provide high-quality evidence on whether intensive preoperative medical weight loss improves outcomes compared to immediate surgical repair in patients with severe obesity, helping to establish evidence-based guidelines for this challenging patient population.</p><p><strong>Trial registration: </strong>NCT05925959 (registered June 22, 2","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"187"},"PeriodicalIF":2.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-operative considerations in relation to groin and ventral hernia repair: local consensus recommendations from the Danish Hernia Database.","authors":"Jacob Rosenberg, M W Christoffersen, M Krogsgaard, N A Henriksen, K Andresen, M K Christensen, A Dorfelt, L Pejtersen, T Sommer, N Wensel, N B Zinther, F Helgstrand","doi":"10.1007/s10029-025-03377-w","DOIUrl":"https://doi.org/10.1007/s10029-025-03377-w","url":null,"abstract":"<p><strong>Background: </strong>While operative technique is central to hernia repair, non-operative factors such as postoperative activity guidance and the use of abdominal binders significantly influence recovery, quality of life, and long-term outcomes. These considerations are variably addressed in clinical practice and are underrepresented in the literature.</p><p><strong>Methods: </strong>This narrative review examines key non-operative aspects of hernia surgery, focusing on groin and ventral hernias. For each type, we discuss postoperative physical activity recommendations, the use and effectiveness of abdominal binders or support binders, and other relevant factors that typically concern the patient during the preoperative visit. As this is a non-systematic review, the recommendations are based on the available literature and consensus discussions within the steering committee of the Danish Hernia Database.</p><p><strong>Results: </strong>Groin hernia repair typically allows for early mobilization and rarely warrants binder use, although anecdotal evidence supports the use of inguinal binders to prevent seromas in large inguinoscrotal hernias. Some patients may feel subjective comfort wearing such binders for a few weeks after surgery. In ventral hernia repair, individualized guidance and use of support binders may be more effective than in groin hernia repair; decreasing postoperative pain and possibly seroma formation. Despite widespread clinical practices, evidence supporting specific activity restriction recommendations remains limited, and considerable variation exists between surgeons and institutions. After consensus discussions, we recommend the immediate resumption of normal daily activities, whereas sports and heavy lifting should wait 2-4 weeks after the operation.</p><p><strong>Conclusion: </strong>Non-operative considerations are important for the patient and often serve as central discussion points during the preoperative visit. A stronger evidence base, improved standardization, and broader implementation of patient-centered tools could enhance recovery, reduce complications, and better align surgical success with patient well-being and satisfaction.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"186"},"PeriodicalIF":2.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanics of the abdominal wall before and after ventral hernia repair using dynamic MRI.","authors":"Victoria Joppin, David Bendahan, Ahmed Ali El Ahmadi, Catherine Masson, Thierry Bege","doi":"10.1007/s10029-025-03337-4","DOIUrl":"https://doi.org/10.1007/s10029-025-03337-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to investigate the use of dynamic MRI to assess abdominal wall biomechanics before and after hernia surgery, considering that such evaluations can enhance our understanding of physiopathology and contribute to reducing recurrence rates.</p><p><strong>Methods: </strong>Patients were assessed using dynamic MRI in axial and sagittal planes while performing exercises (breathing, coughing, Valsalva) before and after their abdominal hernia surgery with mesh placement. Rectus and lateral muscles, linea alba, viscera area, defect dimensions and hernia sac were contoured with semiautomatic process to quantify the abdominal wall biomechanical temporal modifications.</p><p><strong>Results: </strong>This study enrolled 11 patients. During coughing, the axial area of the hernia sac increased by 128.4 ± 199.2%. The sac increased similarly in axial and sagittal planes during Valsalva. Post-surgical evaluations showed a 26% reduction in inter-recti distance and a lengthening of all muscles (p ≤ 0.05). The post-operative rectus abdominis thickness change was negatively correlated with defect width during breathing (p ≤ 0.05). The largest change in linea alba displacement was observed in the surgical site (p = 0.07). Post-operatively, lateral muscles had a larger inward displacement during Valsalva (p ≤ 0.05). Rectus abdominis had a larger outward displacement during breathing (p = 0.09), reduced with the mesh size (p ≤ 0.05). A large inter-individual variability was observed.</p><p><strong>Conclusion: </strong>Using a semi-automatic methodology, an in-depth analysis of the biomechanics of the abdominal wall was conducted, highlighting the importance of a patient-specific assessment. A broader study and consideration of recurrence would subsequently complete this methodological work.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"185"},"PeriodicalIF":2.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes after elective inguinal hernia mesh-repair in patients with inflammatory bowel disease.","authors":"Hans Lovén, Rune Erichsen, Anders Tøttrup, Thue Bisgaard","doi":"10.1007/s10029-025-03362-3","DOIUrl":"10.1007/s10029-025-03362-3","url":null,"abstract":"<p><strong>Background: </strong>Knowledge of long-term outcomes following elective inguinal hernia mesh-repair in patients with inflammatory bowel disease (IBD) remains limited. Pathophysiological differences between Crohn's disease (CD) and ulcerative colitis (UC) may influence mesh-related complications and recurrence risk. The primary objective was to assess the reoperation risk for mesh-related complications, and secondarily, recurrence after inguinal hernia mesh-repair in patients with CD and UC. The impact of fistulising disease (intra-abdominal/perianal) and surgical technique (open/laparoscopic) on both outcomes was also analysed based on the available data.</p><p><strong>Methods: </strong>This nationwide cohort study (2007-2016) followed IBD patients undergoing elective inguinal hernia mesh-repair to assess risks of reoperation for mesh-related complications or recurrence. Risks were estimated using cumulative incidence and Cox regression analyses.</p><p><strong>Results: </strong>Among 1,072 patients with IBD (CD = 264, UC = 698, IBD-unclassified = 110), the five-year reoperation risk was 0.5% for mesh-related complications and 5.7% for recurrence. Fistulising disease was present in 6.9% (n = 74) of all patients with IBD: perianal in 95% (n = 70) and intra-abdominal in 5% (n = 4). There were too few mesh-related complications (n = 5) to support statistical analysis of this outcome. Recurrence risk was not significantly affected by IBD subtype: CD (reference), UC (HR = 1.67, 95% CI: 0.77-3.64), IBD-U (HR = 0.91, 95% CI: 0.24-3.44), or surgical technique: transabdominal preperitoneal (TAPP) (reference), and Lichtenstein (HR = 0.80, 95% CI: 0.43-1.47).</p><p><strong>Conclusion: </strong>This study suggests that inguinal hernia mesh-repair is also safe among IBD patients regardless of subtype, surgical technique, or perianal fistulation. Similarly, recurrence risk was unaffected by these factors. Limited data prevented conclusions on intra-abdominal fistulising disease as a potential risk-factor for poor surgical outcomes.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"183"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of totally visceral sac separation (TVS) and extended view totally extraperitoneal (e-TEP) repair for umbilical and epigastric hernias: a retrospective study.","authors":"Bo Zhuang, Yu Zhou, Shian Yu, Yaoqi Zhang, Gang Li","doi":"10.1007/s10029-025-03370-3","DOIUrl":"https://doi.org/10.1007/s10029-025-03370-3","url":null,"abstract":"<p><strong>Purpose: </strong>Totally visceral sac separation (TVS) is a novel concept proposed for hernia repair, preserving the integrity of the posterior rectus sheath (PRS). The aim of this study was to compare the results of TVS with the extended view totally extraperitoneal (e-TEP) method for umbilical and epigastric hernias.</p><p><strong>Methods: </strong>A retrospective comparison analysis was conducted including 45 e-TEP and 43 TVS procedures performed between June 2021 and June 2024. Baseline characteristics, surgical records, and postoperative information were collected and analyzed for both groups from the electronic medical records system.</p><p><strong>Results: </strong>The baseline characteristics showed no significant differences. The TVS group had a significantly longer mean operative time (230 (36) minutes vs. 190 (84) minutes, P<0.01) and used a smaller mesh area (120 (10) cm² vs. 130 (20) cm², P<0.01). No significant differences were observed between the two groups in terms of quality of life scores, postoperative length of stay, and medical expenses. One patient in the e-TEP group experienced surgical site and mesh infection, requiring mesh removal and resulting in hernia recurrence.</p><p><strong>Conclusion: </strong>Despite its complexity and longer operative time, the TVS approach offers potential advantages in long-term outcomes and complication management for umbilical and epigastric hernias. These findings contribute to the understanding and potential adoption of the TVS technique in hernia repair.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"176"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of topical gentamicin in preventing surgical site infections during hernia mesh repair: experience from developing countries.","authors":"Mohamed Daffalla-Awadalla Gismalla, Monzer Mohammed Abdallah Ibrahim, Mohammed Abdelhaleem Mahmoud, Alsidiek Abdelazeem Hassan Alamalhuda","doi":"10.1007/s10029-025-03372-1","DOIUrl":"https://doi.org/10.1007/s10029-025-03372-1","url":null,"abstract":"<p><strong>Background: </strong>Recently, mesh repair has become a standard treatment for inguinal and ventral hernial disease worldwide. Consequently, mesh-related complications have increased, especially superficial site infections. This study aimed to determine the role of topical gentamicin in reducing superficial surgical site infection.</p><p><strong>Methods: </strong>This was a prospective, cross-sectional, comparative, hospital-based study conducted between July 2022 and March 2023. Patients who underwent elective mesh repair for inguinal or para-umbilical hernia were reviewed. Participants were divided into two groups: the control group (G1), which did not receive topical gentamicin, and the study group (G2), which received topical gentamicin. The surgical site was examined on the 1st, 7th, and 30th postoperative days for signs of infection according to the definitions provided by the Centers for Disease Control Control.</p><p><strong>Results: </strong>A total of 197 fulfilled our inclusion criteria. The infection rate in all study participants (N = 197) was 4.5%. A total of (n = 9) 4.5% SSIs occurred among the 197 patients, with 3.5% (n = 7) in G1 and 1% (n = 2) in G2 (Table 2). Four patients (2.0%) developed a hematoma, all of whom had an inguinal hernia. Three of these patients developed SSI, with two in G1 and one in G2 All infections observed were superficial surgical infections (SSI); No statistical significance was ruled out.</p><p><strong>Conclusion: </strong>Our study sheds light on the use of topical gentamicin in preventing early SSIs following hernia and para-umbilical mesh repair surgery in developing countries. There are no significant differences when using topical gentamicin to prevent surgical site infections.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"184"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is previous radical prostatectomy an adversity for laparoscopic total extraperitoneal approach for inguinal hernia repair? A propensity score case matched study.","authors":"İsmail Ahmet Bilgin, Nur Ramoglu, Volkan Ozben, Orkun Harun Çebi, Omer Burak Argun, Tunkut Salim Doganca, Ali Rıza Kural, Bilgi Baca, İsmail Hamzaoglu, Tayfun Karahasanoglu","doi":"10.1007/s10029-025-03363-2","DOIUrl":"10.1007/s10029-025-03363-2","url":null,"abstract":"<p><strong>Introduction: </strong>Although laparoscopic total extraperitoneal (TEP) procedure has gained wide acceptance for inguinal hernia repair, there is still debate on the optimal technique in patients with a history of previous radical prostatectomy (RP). We aimed to evaluate the feasibility and safety of laparoscopic TEP in patients with a previous history of RP using a propensity score case-match analysis.</p><p><strong>Methods: </strong>This study included male patients undergoing laparoscopic TEP repair between 2013 and 2024. According to the RP status, patients were case-matched based on age, BMI, ASA score, site of hernia and the year of surgery. A total of 162 patients were matched in a 1:5 ratio. The RP and non-RP groups were compared with respect to perioperative outcomes.</p><p><strong>Results: </strong>The RP and non-RP group included 27 and 135 patients, respectively. The rate ofconversion to transabdominal preperitoneal repair (11.1%) or open surgery (14.8%) was significantly higher in the RP group (p<0.001). The RP group had longer operative times (160±57 vs. 94±38, p<0.001). The postoperative complication rates (7.4% vs. 6%), postoperative pain scores, length of stay (1.6±0.9 vs 1.2±0.9 days), time to return to daily life (2.9±1.8 vs 2.6±3.0 days), readmission (3.7% vs 0.7%), long-lasting pain (14.8% vs. 11.8%) and recurrence (0% vs 3.2%) were similar in both groups (p>0.05).</p><p><strong>Conclusion: </strong>Laparoscopic TEP inguinal hernia repair in patients with a history of RP is feasible and safe with a similar morbidity profile but an increased conversion rate and operative time compared to those with no history of RP.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"173"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and outcomes profiles of parastomal hernia after radical cystectomy and ileal conduit urinary diversion: a systematic review.","authors":"Rui Cao, Xiangyu Shao, Junsheng Li","doi":"10.1007/s10029-025-03359-y","DOIUrl":"https://doi.org/10.1007/s10029-025-03359-y","url":null,"abstract":"<p><strong>Introduction: </strong>Parastomal hernia following radical cystectomy and ileal conduit urinary diversion (ICPH) is a prevalent postoperative complication which needed a unified scheme for proper management. This review provided a comprehensive summary of the data regarding the occurrence, risk factors, surgical approaches, mesh placement, postoperative complications, and recurrence rates of ICPH, with the aim of offering valuable insights for the standardized management of ICPH.</p><p><strong>Methods: </strong>Systematic literature search was conducted up to November 2024 using databases including MEDLINE and Elsevier, supplemented by manual screening of relevant journals and reference lists. Data extraction focused on incidence, risk factors, surgical approaches, and postoperative outcomes.</p><p><strong>Results: </strong>A total of 30 studies were included, including 18 retrospective studies and 12 cases. And 3 additional systematic reviews were integrated to extract data concerning the incidence and risk factors of ICPH. The pooled ICPH incidence of 4 studies was 14.36%. Main risk factors included fascial defects ≥ 24 mm, obesity, and female sex. In the choice of surgical approach, minimally invasive techniques dominated (169/367,52%). The most frequently reported methods were the Keyhole (149/328, 45%) and Sugarbaker (113/328, 35%) techniques. In terms of mesh placement, the choice of most cases intraperitoneal placement. The most prevalent postoperative complication was urinary system complications (n = 14). Most of the complications were Clavien-Dindo grade 2 (40/68,59%). Recurrence rates varied widely (0-47%), with Keyhole-associated recurrence up to 52% versus 12.5% for Sugarbaker.</p><p><strong>Conclusion: </strong>ICPH is a clinical complication that deserves the attention of surgeons. Mesh repair is the current mainstream method. Although there are various surgical methods for mesh repair, each has its own advantages and disadvantages, and a large number of clinical studies are still needed to provide the optimal solution. In addition, the effectiveness of prophylactic mesh placement remains controversial.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"180"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of repa for ventral hernias and diastasis: recurrence risk and aesthetic challenges.","authors":"Micaela Milagros Rossi, Digby Aylen Montechiari, Ignacio Portela, Santiago Andrés Flores, Alejandro Rossini, Franco José Signorini, Lucio Obeide","doi":"10.1007/s10029-025-03373-0","DOIUrl":"https://doi.org/10.1007/s10029-025-03373-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate outcomes of the REPA technique in patients with midline ventral or incisional hernias and associated diastasis during long-term follow-up, complemented with computed tomographic (CT) imaging.</p><p><strong>Methods: </strong>A retrospective study including patients who underwent REPA surgery between November 2017 and April 2024 was performed. Demographic data, operative times, postoperative complications, and hospital stay were analyzed. Functional and aesthetic outcomes were assessed using the EHS quality-of-life score. Patients with more than one year since surgery underwent a CT. Based on CT results, patients were divided into two groups to compare (recurrence/no recurrence).</p><p><strong>Results: </strong>A total of 142 patients underwent REPA. The associated diastasis had a mean size of 33.8 ± 13.3 mm. The median follow-up time was 47.9 ± 23.97 months. 62 patients completed the EHS-QoL questionnaire. Regarding aesthetics, the general shape of the abdomen had a mean score of 5.66 (± 3.55) and the hernia site and scar scored 3.37 (± 3.58). Among the 33 patients who underwent follow-up CT scans, recurrence was identified in 9 cases (27.3%). Statistically significant differences were observed in BMI (26.01 ± 5.45 vs. 30.52 ± 4.99 kg/m², p = 0.04) and diastasis size (30.3 ± 8.95 vs. 56.6 ± 17.4 mm, p < 0.001) between patients with and without recurrence.</p><p><strong>Conclusion: </strong>Our findings suggest a higher risk of recurrence in patients with diastasis > 5 cm and obesity, highlighting the need for careful patient selection. Furthermore, overall abdominal shape may be unsatisfactory despite minimal scarring. Overweight and obesity should be considered exclusion criteria to optimize functional and aesthetic outcomes.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"172"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Umbilical hernia repair by the eTEP, a reproducible and valuable technique.","authors":"Junsheng Li, Liangqi Lu, Xiangyu Shao, Yong Wang","doi":"10.1007/s10029-025-03357-0","DOIUrl":"https://doi.org/10.1007/s10029-025-03357-0","url":null,"abstract":"<p><strong>Background: </strong>Umbilical hernia is a common surgical condition, and mesh repair is generally recommended to reduce recurrence rates. Various techniques have been employed, each with its own advantages and disadvantages. The enhanced-view totally extraperitoneal (eTEP) approach offers the benefit of placing the mesh outside the abdominal cavity while maintaining a minimally invasive approach. However, it is associated with longer operative times and requires a higher level of surgical expertise. In this study, we present our method of eTEP for umbilical hernia repair, which has proven to be safe, effective, and highly reproducible.</p><p><strong>Methods: </strong>Patients with umbilical hernias and defect sizes larger than 1 cm were prospectively enrolled. All patients underwent repair using the eTEP technique, which featured an inferior port position and a caudal-to-cranial dissection approach. Detailed procedural techniques and surgical skills are described, and perioperative outcomes were recorded.</p><p><strong>Results: </strong>A total of 26 umbilical hernias were repaired using the eTEP technique, with no conversions to an open approach. The mean operative time was 101.8 ± 31 min (range: 47 to 185 min), and the average postoperative hospital stay was 1.8 ± 0.8 days (range: 1 to 5 days). There were no cases of surgical site infection, skin necrosis, wound dehiscence, bowel obstruction, urinary complications, or recurrence.</p><p><strong>Conclusion: </strong>The eTEP approach for umbilical hernia repair is a safe, efficient, and reproducible alternative to traditional methods. Its unique port positioning, tailored dissection, and optional mesh fixation contribute to reduced complications and improved patient outcomes. Future studies should focus on long-term follow-up to validate the durability and effectiveness of this technique.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"178"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}