Hernia最新文献

{"title":"Who's paying? Payor status significantly affects hospital readmission rates after ventral hernia repair.","authors":"Agnes Premkumar, Carlos Balthazar da Silveira, Ana Rasador, Paul Kang, Vikram Deka, Thomas Gillespie, Conrad Ballecer","doi":"10.1007/s10029-026-03838-w","DOIUrl":"https://doi.org/10.1007/s10029-026-03838-w","url":null,"abstract":"<p><strong>Purpose: </strong>Over 350,000 ventral hernia repairs (VHRs) are performed annually. However, there are numerous socioeconomic disparities in obtaining elective repair. This study aimed to evaluate the impact of payer status after ventral hernia repair within a national cohort on thirty-day readmission rates, hospital costs, and discharge disposition.</p><p><strong>Methods: </strong>A retrospective chart review was conducted of the Nationwide Readmission Database (NRD) for all VHRs between 2016 and 2022. Demographic characteristics along with medical comorbidities, complications after VHR, and all-cause 30-day readmissions were collected. Logistic regression was used to assess associations between payer status and overall outcomes.</p><p><strong>Results: </strong>Medicaid (12.1%) and Medicare (12.4%) were the primary payer statuses among all readmissions. Patients with private insurance (OR 0.71, p < 0.001) and self-pay (OR 0.81, p < 0.001) had lower odds of thirty-day readmission compared to Medicaid patients. Patients discharged to a short-term facility, designated center, home healthcare, or against medical advice were more likely to be re-admitted compared to patients who were discharged home (p < 0.05). The most common cause for re-admission among all patients was post-operative/device infection. Medicaid patients had the highest rate of such infections (2.20 vs. 1.68 Medicare, 1.45 Private, and 1.56 Self-Pay).</p><p><strong>Conclusions: </strong>Payer status significantly influences readmission rates, cause for readmission, and overall discharge disposition among VHR patients. These findings might implicate underlying socioeconomic disparities in receiving adequate post-operative care. Future studies should investigate how insurance structures impact postoperative care and clinical outcomes in hernia surgery.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206771","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":"Energy profile of laparoscopic TEP bilateral inguinal hernia repairs.","authors":"Ray Meng See, Calvin Enpeng Chen, Theresa Harbig, Luca T Frericks, Jens Rolinger, Markus D Enderle, Davide Lomanto, Sujith Indeewara Wijerathne","doi":"10.1007/s10029-026-03878-2","DOIUrl":"https://doi.org/10.1007/s10029-026-03878-2","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is effective but technically demanding, with a long learning curve conventionally characterized using operative time. Electrosurgical generator data is a routinely produced yet underexploited signal that may yield an objective, phase-specific descriptor of intraoperative performance. We aimed to characterize the intraoperative electrosurgical energy profile of bilateral TEP repairs performed by an experienced surgeon and to assess its consistency across cases, as a feasible preliminary step towards future objective referencing of energy profile usage in hernia surgery.</p><p><strong>Methods: </strong>Eight adult patients undergoing elective bilateral TEP repair for primary, non-complex inguinal hernia between July 2023 and March 2024 were included in this prospective single-center observational study. Intraoperative electrosurgical data were captured by a data logger connected to the electrosurgical unit and synchronized with laparoscopic video. All procedures were performed by an experienced and specialized surgeon. The procedure was divided into nine phases; energy emitted per minute and the duty cycle per phase were analyzed, and inter-case consistency of the duty-cycle profile was quantified using Pearson correlation.</p><p><strong>Results: </strong>A case-specific digital energy profile combining monopolar and bipolar use was mapped for each patient. Intervention duration ranged from 41 to 85 min (median 56.5), total activation duration from 2.09 to 5.45 min (median 3.77), and total emitted energy from 1670 to 7224 J (median 5043.5). Energy use was comparable between hernias of maximum EHS grade 1 and 2, whereas hernias of maximum EHS grade 3 showed more than 50% higher energy use. The duty cycle was highest during the main dissection phases and decreased toward parietalisation and this was consistent across the cases analysed. No postoperative complications occurred, and all patients were discharged the same day.</p><p><strong>Conclusion: </strong>The intraoperative electrosurgical energy profile of bilateral TEP repairs by an experienced surgeon is reproducible across cases and resolves into a phase-specific pattern that mirrors the underlying surgical anatomy. This exploratory analysis provides a foundation for subsequent comparative studies in which trainees could objectively compare their electrosurgical behavior against an experienced reference, complementing existing learning aids in TEP and other phase-structured procedures.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206796","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":"Outcomes of abdominal wall reconstruction with and without concurrent skin excision: a single-surgeon retrospective cohort study.","authors":"A Iqbal, M Baltatzis, R Shaban, A Tyurkylmaz, S Jamdar, A J Sheen","doi":"10.1007/s10029-026-03865-7","DOIUrl":"https://doi.org/10.1007/s10029-026-03865-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;The primary objective of this study was to evaluate and compare the clinical outcomes of incisional hernia repairs performed by a single surgeon, with and without concurrent skin excisions. Given the increasing prevalence of incisional hernias and the growing need for comprehensive abdominal wall reconstruction, this study aimed to determine whether the addition of skin excision significantly affects postoperative outcomes, including length of hospital stay (LOS), complication rates, and wound infection incidence. Furthermore, the study explored the influence of patient-related factors such as body mass index (BMI) and hernia size on surgical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was conducted on 94 patients who underwent incisional hernia repairs between 2019 and 2023. These patients were divided into two groups: those who underwent hernia repair without skin excision (n = 52, 55%) and those who had skin excision as part of the procedure (n = 42, 45%). Key outcome measures included LOS, postoperative complications, and wound infection rates. Additionally, patients were stratified based on BMI (≥ 30 vs. &lt;30) to assess its impact on surgical outcomes. Statistical analysis was performed using Pearson's chi-square and one-way ANOVA tests, with significance defined as p &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median age of patients in the study cohort was 57 years (range: 24-88 years). Patients who did not undergo skin excision had a significantly shorter LOS compared to those who underwent concurrent skin excision (mean: 2.8 days vs. 6.8 days, p = 0.023). Despite the extended hospitalisation in the skin excision group, overall complication rates were comparable between the two cohorts (34% vs. 31%, p = 0.436). There was no statistically significant difference in wound infection rates between the no-skin-excision and skin-excision groups (23% vs. 16%, p = 0.441). BMI was found to be a significant factor influencing postoperative outcomes. Patients with a BMI of ≥ 30 (n = 10) exhibited a markedly higher incidence of postoperative complications and wound infections (p &lt; 0.001), though BMI did not appear to affect LOS (p = 0.962). Additionally, the size of the hernia was an important determinant of surgical outcomes. Larger hernias (≥ 6 cm) were associated with a longer LOS compared to smaller hernias (mean: 6.4 days vs. 2.8 days, p = 0.051). While there was a trend towards a higher complication rate in larger hernia repairs, the difference did not reach statistical significance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients undergoing concurrent skin excision experienced a longer hospital stay, whereas postoperative complication and wound infection rates were comparable between groups on univariable analysis. However, without multivariable adjustment, these findings should be interpreted as associations rather than evidence of an independent effect of skin excision. Patients with BMI ≥ 30 had high","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206753","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":"Feasibility of automated registration of Patient-Reported Outcome Measures (PROMs) for inguinal hernia surgery : a single-centre pilot study.","authors":"R R Meuzelaar, H V Smit, F P J den Hartog, A H W Schiphorst, P J Tanis, J P J Burgmans","doi":"10.1007/s10029-026-03822-4","DOIUrl":"10.1007/s10029-026-03822-4","url":null,"abstract":"<p><strong>Purpose: </strong>National registries have the potential to improve quality of inguinal hernia surgery by monitoring provided care and comparing outcomes. Patient-reported outcome measures (PROMs) are essential for assessing quality as they capture key outcomes directly from the patient's perspective. This pilot study evaluated feasibility of automated PROMs registration up to 2 years postoperatively with minimal administrative burden in a high-volume hernia clinic.</p><p><strong>Methods: </strong>Adults who underwent elective inguinal hernia repair and received PROMs questionnaires between January 18, 2023, and August 25, 2025, were prospectively included. Patients received secure email invitations to complete questionnaires through the hospital's patient portal at baseline and at 6-8 weeks (short-term), 3 months, 1 year, and 2 years postoperatively. PROMs included pain, functional recovery, satisfaction, and hernia recurrence. The primary outcome was the response rate at different follow-up time points (target rate: 60%). Key secondary outcomes included physician-assisted response rates and responder versus non-responder differences.</p><p><strong>Results: </strong>A total of 3,628 patients were included. Preoperative and short-term response rates were 77.7% and 63.2%, respectively. Postoperative response rates declined to 47.7% (3 months), 44.2% (1 year), and 43.8% (2 years). Younger age and a higher burden of comorbidities were associated with non-response.</p><p><strong>Conclusion: </strong>This study demonstrated feasibility of automated PROMs at baseline and short-term follow-up, but highlights the challenge of declining response rates over time and representativeness of the responding population. Integrating this approach into a national registry could improve data collection and overall efficiency. Strategies to optimize response rates and representativeness should be explored.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193205","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":"Macroscopic, radiologic, and microscopic analysis of explanted abdominal wall prosthesis.","authors":"Léna Christ, Benoit Romain, Guillaume Philouze, Nicole Neumann, Anne Lejay, Juliette Tabouret, Nabil Chakfé","doi":"10.1007/s10029-026-03880-8","DOIUrl":"https://doi.org/10.1007/s10029-026-03880-8","url":null,"abstract":"<p><strong>Purpose: </strong>Characterize the textile structure, degradation patterns, and calcification of explanted parietal reinforcement implants (PRI), in order to better understand potential mechanisms contributing to mesh-related complications.</p><p><strong>Methods: </strong>A multimodal analytical approach combining macroscopic examination, high-resolution radiographic imaging and microscopic analysis was performed before and after removal of surrounding biological tissues on explanted PRI.</p><p><strong>Results: </strong>Twenty-two explanted PRI were analyzed, including five biosynthetic meshes and seventeen fully synthetic non-resorbable meshes. Mean implantation duration was 41 months (range, [0-220]). Indications for explantation were hernia recurrence (n = 14, 64%), mesh infection (n = 4, 18%), unrelated surgery (n = 3, 14%), and bowel obstruction (n = 1, 4%). Macroscopic analysis showed encapsulation within biological tissues (n = 16), rigidity (n = 6), and fragmentation (n = 3), sometimes combined. Radiographic imaging revealed suggestive calcifications in four explants, and suggestive fibrosis and/or milder mineralized deposits in twelve. Nineteen non-resorbable meshes underwent digital optical microscopy after enzymatic cleaning (2 explants each contained 2 devices). Textile structures included warp-knitted meshes (n = 16), weft-knitting mesh (n = 1), and nonwoven materials (n = 2); six devices also incorporated a plastic membrane. Monofilament yarns predominated (n = 15) whereas multifilament yarns (n = 4) showed signs of fibrillation. Fixation systems included staples (n = 3) and suture threads (n = 6). Structural abnormalities included holes (n = 7), clean cuts (n = 7), tearing (n = 1), and forceps marks (n = 3), variably attributable to surgical/handling artefacts or pre-existing degradation, though this could not be established with certainty.</p><p><strong>Conclusion: </strong>This pilot study demonstrates the feasibility of a multimodal approach for characterizing explanted PRI. Larger studies are needed to clarify mesh failure mechanisms and thereby optimize implant selection and surgical use.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193225","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":"Chronic pain and aesthetics after cosmetically motivated open primary ventral hernia repair: a survey- and register-based nationwide study.","authors":"Sofie Anne-Marie Skovbo Jensen, Anders Gram-Hanssen, Hugin Reistrup, Jacob Rosenberg, Jason Joe Baker","doi":"10.1007/s10029-026-03879-1","DOIUrl":"https://doi.org/10.1007/s10029-026-03879-1","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to assess patient-reported outcomes among patients undergoing elective open primary ventral hernia repair exclusively motivated by cosmetic concerns.</p><p><strong>Methods: </strong>This Danish nationwide study included patients who underwent elective open ventral hernia repair from 2014 to 2024. Patients were identified through the Danish National Patient Register and invited to complete a digital survey. Survey data on surgical motivation and patient-reported outcomes were linked with data from the Danish Ventral Hernia Database. Outcomes included severe chronic pain, self-reported recurrence, cosmetic improvement, cosmetic satisfaction, and changes in quality of life. Targeted average treatment effects were estimated using g-computation.</p><p><strong>Results: </strong>Among 14,263 eligible individuals, the survey response rate was 78%. Of respondents, 393 reported cosmetic-only motivation for surgery, and 8,016 reported physical symptoms as motivation. The population-averaged adjusted prevalence of severe chronic pain was 5.9% (95% CI 3.8-8.0) in the cosmetic-only motivation group versus 10.9% (95% CI 10.2-11.6) in the physical motivation group. Recurrence was likewise less frequent (7.0%, 95% CI 4.7-9.3 vs. 13.1%, 95% CI 12.3-13.8). The proportion reporting no improvement in quality of life did not differ significantly (8.6% vs. 6.1%; absolute difference - 2.6%, 95% CI -5.3-0.2), nor did Abdominal Hernia Questionnaire appearance scores (18.2 vs. 18.5; difference 0.3, 95% CI 0.0-0.5). Median follow-up was 6.8 and 5.2 years, respectively.</p><p><strong>Conclusion: </strong>Most patients undergoing open repair of a small primary ventral hernia for cosmetic reasons experienced improved abdominal appearance and quality of life, while risks of chronic pain and recurrence remained relatively low.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181228","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":"Perineural versus intravenous dexmedetomidine as an adjuvant for ilioinguinal/iliohypogastric nerve block in open inguinal hernia repair: a randomised controlled trial.","authors":"Pinyada Pisutchareonpong, Chanyaphak Chumthong, Nattanicha Sirimanakul, Nutnicha Paenee, Pichchaporn Praserdvigai, Piyasak Vitayaburananont, Suphakarn Techapongsatorn, Amarit Tansawet, Wisit Kasetsermwiriya, Issaree Loapiamthong, Pakkapol Sukvibul, Pruchwilai Nuchpramool","doi":"10.1007/s10029-026-03866-6","DOIUrl":"10.1007/s10029-026-03866-6","url":null,"abstract":"<p><strong>Purpose: </strong>Dexmedetomidine is widely added to peripheral nerve blocks, but whether the perineural or intravenous route provides better analgesia-and at what haemodynamic cost-is unclear in inguinal hernia repair. We compared the two routes as adjuncts to an ilioinguinal/iliohypogastric (II/IH) nerve block.</p><p><strong>Methods: </strong>This single-centre, triple-blind randomised controlled trial enrolled 90 adults (ASA I-III) undergoing elective open inguinal hernia repair. All received an ultrasound-guided II/IH block (0.5% bupivacaine with epinephrine, 20 mL) and standardised tumescent local anaesthesia, and were randomised 1:1:1 to perineural dexmedetomidine 1 µg/kg (DexLA), intravenous dexmedetomidine 1 µg/kg over 10 min (DexIV), or placebo (Control). The primary outcome was movement-evoked visual analogue scale (VAS, 0-100) pain at 6 h, analysed by intention-to-treat.</p><p><strong>Results: </strong>Movement VAS at 6 h was lower with perineural dexmedetomidine (DexLA 10.3 ± 10.3) than DexIV (20.0 ± 17.4) or Control (22.0 ± 20.6; overall p = 0.018): DexLA versus Control - 11.7 (95% CI - 21.9 to - 1.4; p = 0.022), whereas DexIV did not differ from Control (p = 0.888). This reduction reached the established minimum clinically important difference of approximately 10 points, although pain was low overall. Time to first opioid was similar (p = 0.723). Bradycardia was more frequent with DexIV (20.0%) than DexLA (3.3%) or Control (6.7%; DexIV vs DexLA p = 0.040); hypotension occurred in 43.3%, 40.0% and 20.0% (p = 0.151).</p><p><strong>Conclusion: </strong>Perineural-but not intravenous-dexmedetomidine produced a clinically relevant reduction in early movement-evoked pain, whereas intravenous dexmedetomidine added bradycardia without analgesic benefit. If dexmedetomidine is used in this setting, the perineural route is preferable.</p><p><strong>Trial registration: </strong>Thai Clinical Trials Registry TCTR20220208002; registered 7 February 2022.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181256","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":"Prospective results of locally delivered low-cost mesh inguinal hernia repair in a low resource setting.","authors":"Anthony Abbot Kamara, Foday Daddy Mansaray, Daniel Lavalie, Mark Szymankiewicz, Lesley M Hunt","doi":"10.1007/s10029-026-03874-6","DOIUrl":"10.1007/s10029-026-03874-6","url":null,"abstract":"<p><strong>Purpose: </strong>To assess patient outcomes after locally processed ultra-low-cost hernia mesh placement became routine practice in a government hospital in one of the world's poorest countries.</p><p><strong>Methods: </strong>Observational study with comprehensive prospective data collection via electronic registry from June 2023 to January 2026. Interrogation of database after 2.5 years assessed demographics, hernia types and complexity, short term complications and outcomes at 2 years.</p><p><strong>Results: </strong>Between 01.06.2023 and 01.06.2025, 121 inguinal hernia repairs were repaired with mesh. 76% of inguinal hernias were primary and 24% were recurrent or re-recurrent. No Surgical Site Infection was seen after primary inguinal hernia repair. A 10% superficial wound infection rate was seen after repair of recurrent and re-recurrent inguinal hernias. No mesh infections occurred. Heavy use of prophylactic antibiotics was observed but reduced during the study period. This is a report of the first two years of an on-going service and patients are at varying time points post-surgery. 108 repairs (89%) were > one year post-surgery and one-year FU is documented for 108 repairs (100%). No hernia recurrences identified to date 0% 95% CI [0, 3.35]. 66 repairs were > 2 years post-surgery and 2-year FU is documented for 58 repairs (88%). No hernia recurrences identified to date 0% (95% CL: 0%, 6.16%).</p><p><strong>Conclusion: </strong>Robust, prospective outcome monitoring is feasible in low-income-countries, even outside of the clinical trial situation. Structured training and local implementation have produced good early hernia outcomes.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166206","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":"Fragility of randomized clinical trials comparing surgical approaches for inguinal hernia repair: a systematic review.","authors":"Maria Clara Morais, Denise Padilha Abs de Almeida, Beatriz Laus Pereira Lima, Leticia Hanna Moura da Silva Gattas Graciolli, Aisulu Jessup, Maria Fernanda Andrade, Raquel Nogueira, Leandro Totti Cavazzola, Flavio Malcher, Diego Laurentino Lima","doi":"10.1007/s10029-026-03869-3","DOIUrl":"10.1007/s10029-026-03869-3","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized clinical trials (RCTs) remain the reference standard for estimating causal effects of surgical interventions when appropriately designed and conducted. However, P values alone do not describe how sensitive a dichotomous statistical-significance classification is to small changes in outcome counts. The Fragility Index (FI) and Reverse Fragility Index (RFI) are post hoc descriptive metrics that quantify the number of outcome-status changes required to alter statistical significance. This study aimed to evaluate FI/RFI for inguinal hernia repair (IHR) RCT findings, assess individual complication endpoints, and examine associations with sample size and conflict-of-interest reporting.</p><p><strong>Methods: </strong>Embase, PubMed, LILACS, and ClinicalTrials.gov were searched through June 2025 for RCTs comparing open, laparoscopic, or robotic inguinal hernia repair with dichotomous primary outcomes. FI, RFI, and sample-size-adjusted quotients were calculated from reconstructed 2 × 2 tables using two-sided Fisher exact tests. Individual complications and associations with trial characteristics were analyzed.</p><p><strong>Results: </strong>Forty-two RCTs comprising 14,505 patients and 44 primary comparisons were included; all eligible comparisons evaluated laparoscopic versus open repair. Twelve comparisons were significant, with a median FI of 4 (IQR, 3-5.25); 4 (33.3%) had an FI of 3 or less. Among 31 nonsignificant comparisons, the median RFI was 5 (IQR, 3.5-6.5). All 4 significant individual-complication results had an FI of 3 or less (median, 1). Significance classification differed between reported and recalculated P values in 4 of 78 extracted comparisons. FI was not significantly correlated with sample size.</p><p><strong>Conclusions: </strong>Randomized trials remain central to comparative evidence in inguinal hernia repair. FI and RFI provide complementary post hoc context regarding how many outcome-status changes would alter a dichotomous significance classification and should be interpreted alongside prespecified trial design, effect estimates, confidence intervals, P values, sample size, missing data, and clinical relevance.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148472","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":"Early structured rehabilitation following open retromuscular incisional hernia repair: a prospective randomized controlled trial.","authors":"Matas Pažusis, Linas Venclauskas, Petras Mikučionis, Vytautas Streckis, Mindaugas Kiudelis","doi":"10.1007/s10029-026-03872-8","DOIUrl":"10.1007/s10029-026-03872-8","url":null,"abstract":"<p><strong>Introduction: </strong>Incisional hernias remain a common postoperative problem for general surgeons. In recent years, early postoperative rehabilitation has gained increasing attention as a potential strategy to enhance recovery following abdominal wall reconstruction. This study aimed to evaluate whether structured early postoperative rehabilitation improves objectively measured abdominal wall and trunk muscle functional recovery after open retromuscular (Rives-Stoppa) incisional hernia repair while maintaining postoperative safety.</p><p><strong>Materials and methods: </strong>Thirty adults undergoing elective open retromuscular (Rives-Stoppa) repair of European Hernia Society W2 incisional hernias were randomized to structured postoperative rehabilitation (n = 15) or standard postoperative care (n = 15). Baseline and approximately 2-month postoperative trunk muscle performance were assessed using Biodex dynamometry. The rehabilitation program consisted of supervised, progressive exercises initiated at postoperative week 3 and delivered according to the standardized study protocol. The primary analyses compared individual patient-level changes in trunk flexor and extensor peak torque between groups at angular velocities of 60°/s and 90°/s using the Mann-Whitney U test. Secondary outcomes included additional dynamometric parameters and postoperative clinical outcomes.</p><p><strong>Results: </strong>Thirty patients were included in the analysis. Between-group comparisons demonstrated a statistically significant difference only for the change in trunk flexor peak torque at 90°/s, favoring the rehabilitation group (Δ + 34.3 vs. - 3.8 N·m; Mann-Whitney U = 80.0, p = 0.023). Between-group differences were not statistically significant for trunk flexor peak torque at 60°/s (p = 0.081), trunk extensor peak torque at 60°/s (p = 0.224), or trunk extensor peak torque at 90°/s (p = 0.254). Because four primary peak-torque comparisons were performed without adjustment for multiplicity, the isolated statistically significant finding should be interpreted cautiously. No apparent increase in postoperative complications was observed in the rehabilitation group. Two recurrences occurred during the 12-month follow-up, both in the control group. However, the study was not powered to evaluate recurrence.</p><p><strong>Conclusions: </strong>Structured early postoperative rehabilitation was associated with a greater improvement in trunk flexor peak torque at 90°/s compared with standard postoperative care. No statistically significant between-group differences were observed for the other assessed peak-torque outcomes. Given the small sample size, baseline imbalances, multiple unadjusted comparisons, and effort-dependent nature of dynamometric testing, the findings should be considered exploratory and hypothesis-generating. Larger adequately powered randomized trials incorporating patient-centered outcomes are required.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108851","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}