Hernia最新文献

{"title":"Open inguinal hernioplasty under local, spinal and general anaesthesia: a comparative study.","authors":"Abirami J Raghunath, Subhankar Paul, Keddy Janakiraman Raghunath","doi":"10.1007/s10029-025-03295-x","DOIUrl":"https://doi.org/10.1007/s10029-025-03295-x","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair is one of the most common operations performed in General Surgery accounting for about 10-15% of all surgeries. Inguinal hernia repair can be done under local, spinal or general anaesthesia. Although specialized hernia centres routinely use local anaesthesia for uncomplicated open inguinal hernia repair, very few surgeons adopt this technique, and prefer performing surgery under spinal or general anaesthesia. We compared the short-term outcomes following open inguinal hernia mesh repair under local, spinal and general anaesthesia in our hospital.</p><p><strong>Aims and objectives: </strong>(1) To compare the post-operative pain scores among the three groups. (2) To compare the duration of surgery in minutes, the duration of analgesia, analgesic requirement, the time of return to normal activity such as walking, the time of initiation of diet, and the time of voiding after the surgery. Also to compare any complications, such as urinary retention, need for catheterization, nausea and/or emesis, and the length of hospital stay. (3) To observe the impact on health-related quality of life according to EuroQol and patient satisfaction and acceptance of the type of anaesthesia for the procedure.</p><p><strong>Methods: </strong>A single centre non-randomised, prospective, observational study was performed in 135 patients undergoing inguinal hernia repair under local (LA), spinal (SA) or general anaesthesia (GA), with 45 patients in each arm, over the span of one year. After approval from the Ethical Committee, and proper informed consent, patients above 18 years of age who were to undergo uncomplicated open inguinal hernioplasty were recruited for the study. Lichtensteins tension-free hernioplasty was performed in all cases. The duration of the procedure was calculated from the time of induction or infiltration of local or spinal anaesthesia, till the end of dressing, or extubation in case of general anaesthesia. The duration of analgesia was calculated from the end of the procedure to the feeling of first pain as recorded in the questionnaire. A standard postoperative protocol was employed to determine the pain scores for the first 7 days and also to compare the short-term outcomes i.e., duration of analgesia, return to normal activity, complications, post-operative nausea and emesis, analgesic requirement, urinary retention, length of hospital stay, health-related quality of life and patient satisfaction and acceptance were recorded according to standard proforma and EuroQol questionnaire. All the statistical analysis was carried out by SPSS version 16.0.</p><p><strong>Results: </strong>The mean pain scores were lower in the LA group as compared to SA and GA groups from POD-1 to POD-6 (p < 0.001). However, the values from the 7th post-operative days were similar in all three groups and statistically insignificant (p = 0.09). The outcomes such as duration of analgesia, return to activity such as wal","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"121"},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648423","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":"Planned iliohypogastric neurectomy for prevention of chronic pain after inguinal hernia repair.","authors":"Kazım Gemici, Ersin Özeren","doi":"10.1007/s10029-025-03283-1","DOIUrl":"10.1007/s10029-025-03283-1","url":null,"abstract":"<p><strong>Purpose: </strong>The present study aimed to investigate the effect of planned ilohypogastric neurectomy (IHPN) in preventing chronic postoperative inguinal pain (CPIP) after anterior herniorrhaphy (AH).</p><p><strong>Materials and methods: </strong>This prospective, randomized study was conducted between 2016 and 2023. Emergency and incarcerated hernia cases, bilateral inguinal hernias, cases with complications such as postoperative hematoma infection, cases in which the neuroanatomy of the inguinal region was unintentionally damaged, femoral hernias, and paraplegic patients with loss of sensation who underwent anterior inguinal herniorrhaphy with prolene mesh were excluded, and the remaining 1375 patients were included in this study. The patients were randomized into preoperative control and study groups. After further excluding 247 patients (18%) in whom the IHN could not be identified during the operation, 82% of the 1375 patients (n = 1128) were included in this study. In the control group, the RCA segment of the IHN that would remain under the mesh was preserved (control group = G1 = 534). The second group in which this segment of the RCA was excised comprised the study group (G2 = 594). Two groups were prospectively followed and pain scores (PS) were recorded regularly with a 4-point scale. The average follow-up period was 15 months (range 11-19 months) in G1 and 14 months (range 10-18 months) in G2.</p><p><strong>Results: </strong>The number of patients with CPIP was 68 in G1 and 19 in G2, this difference was found to be statistically significant (p: < 0.001). There were 19 patients in G1 and 41 patients in G2 with loss of sensation in the operation area, and a significant difference was detected in this respect (p = 0.012).</p><p><strong>Conclusion: </strong>The rate of developing CPIP was significantly lower in patients who underwent IHPN during anterior herniorrhaphy than in those who did not undergo IHPN. The subjective nature of the pain sensation complicates measuring and scoring this sensation and methodologically limits the study.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"120"},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614318","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":"Mind the gap: pre-operative diastasis recti increases trocar site hernia risk after laparoscopic cholecystectomy.","authors":"Sarah Lund, Maxwell Mirande, Cecilia Mitchell, Clark Zheng, Sanjna Rajput, Erica Loomis, Stephanie Heller, Henry Schiller, Daniel Stephens, Mariela Rivera","doi":"10.1007/s10029-025-03302-1","DOIUrl":"https://doi.org/10.1007/s10029-025-03302-1","url":null,"abstract":"<p><strong>Purpose: </strong>Trocar site hernias impact 1-10% of patients undergoing a laparoscopic cholecystectomy, typically at the 10 mm port site. Risk factors identified for trocar site hernias include obesity and age; however, little is known about the impact of pre-existing diastasis rectus abdominus (DRA) on trocar site hernia rates. Therefore, we aimed to determine the impact of pre-operative DRA on trocar site hernia rates after laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients undergoing a laparoscopic cholecystectomy for benign gallbladder disease at a single institution from January 2010 to May 2020. CT scan review was used to determine the presence of pre-operative DRA and to diagnose trocar site hernia. Logistic regression was used to determine the factors associated with development of a trocar site hernia.</p><p><strong>Results: </strong>Of the 2,460 patients who underwent a laparoscopic cholecystectomy, 545 (22%) had both a pre- and post-operative CT scan and were included in analysis, with a 1.5 year median length of follow-up. Overall, 434 patients (80%) had pre-operative DRA and 88 patients (16%) developed a trocar site hernia. On logistic regression, presence of DRA was significantly associated with development of a trocar site hernia (OR = 4.12, 95% CI=[1.72,12.24], p = 0.004), while controlling for location of 10 mm port, BMI, age, sex, ASA classification, smoking status, whether surgery was elective, and presence of pre-operative umbilical hernia.</p><p><strong>Conclusions: </strong>Radiologic diagnosis of both DRA and a trocar site hernia is highly prevalent within patients who undergo a laparoscopic cholecystectomy. Further, the presence of pre-operative DRA is significantly associated with development of a trocar site hernia after laparoscopic cholecystectomy.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"114"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614828","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 postoperative outcomes in a retrospective propensity score-matched comparison of robotic extended totally extraperitoneal (r-eTEP) and extended totally extraperitoneal (eTEP) repair for ventral hernia.","authors":"Asem Al-Salemi, Nader El-Sourani, Maximilian Bockhorn, Fadl Alfarawan","doi":"10.1007/s10029-025-03293-z","DOIUrl":"https://doi.org/10.1007/s10029-025-03293-z","url":null,"abstract":"<p><strong>Background: </strong>The extended totally extraperitoneal technique (eTEP) is a novel approach for ventral hernia repair. This technique has been recently advanced using robotics (r-eTEP). The aim of this study is to perform a comprehensive analysis of the initial results of r-eTEP and to evaluate the safety and efficacy of this technique compared to the eTEP technique.</p><p><strong>Methods: </strong>This is a monocentric retrospective study of patients with ventral hernias who underwent surgery via eTEP or r-eTEP in our department between 2019 and 2023. Propensity score matching was applied to compare the groups. Preoperative patient and hernia characteristics, intraoperative findings, and postoperative outcomes were subsequently analysed.</p><p><strong>Results: </strong>Patient demographics were comparable between the groups. The r-eTEP group had a significantly greater proportion of M3 hernias (p = 0.006), M4 hernias (p = 0.020), incisional hernias (p = 0.002), and hernias with rectus diastasis (p < 0.001). The r-eTEP group had a significantly larger hernia defect (p = 0.003) and larger mesh size (p = 0.015). The r-eTEP group had a shorter hospital stay (p < 0.001) and shorter operative time, though not statistically significant (p = 0.211). Intraoperative and postoperative complications, as well as postoperative pain, were comparable between the groups.</p><p><strong>Conclusion: </strong>The findings of the present study show that the r-eTEP technique may offer potential benefits as the overall hospital stay was shorter while intraoperative and postoperative complications were comparable for both techniques.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"119"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673670","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":"Evaluating surgical techniques for incarcerated incisional hernia: laparoscopic vs. Open repair in a tertiary care setting.","authors":"Kayhan Özdemir, Emrah Akin, Ali Muhtaroğlu, Burak Kamburoğlu, Emre Gönüllü, Zülfü Bayhan, Fatih Altintoprak","doi":"10.1007/s10029-025-03311-0","DOIUrl":"10.1007/s10029-025-03311-0","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to compare the outcomes of laparoscopic versus open repair techniques in patients undergoing emergency surgery for incarcerated incisional hernia in a tertiary care setting.</p><p><strong>Methods: </strong>A prospective evaluation was conducted on 45 patients who underwent emergency laparoscopic and open repair for incarcerated incisional hernia between 2018 and August 2021. Patients were divided into two groups based on the surgical technique used: laparoscopic (n = 15) and open repair (n = 30). Key variables analysed included demographic data, body mass index, American Society of Anesthesiologists scores, operative time, perioperative bleeding, length of hospital stay, postoperative complications, European Hernia Society Quality of Life pain score, and recurrence rates during follow-up.</p><p><strong>Results: </strong>Significant differences were found between the laparoscopic and open repair groups regarding pain scores, length of hospital stay, and amount of perioperative bleeding. The laparoscopic repair group demonstrated reduced pain, shorter hospital stays, and less perioperative bleeding compared to the open repair group.</p><p><strong>Conclusion: </strong>This study shows that laparoscopic repair for incarcerated incisional hernia offers significant advantages over open repair. These findings support the preference for laparoscopic repair in the emergency surgical management of incarcerated incisional hernia in appropriate patients.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"116"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614802","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":"Balloon dissection for robotic totally extra-peritoneal (rTEP) inguinal herniorrhaphy: description of a modified technique and report on 97 consecutive patients.","authors":"Karim S Trad, Shankar S Thiru, Thomas P Stirrat, Paul J Marino, Elizabeth R Prevou, Margaret E Greer, Yewande R Alimi","doi":"10.1007/s10029-025-03312-z","DOIUrl":"https://doi.org/10.1007/s10029-025-03312-z","url":null,"abstract":"<p><strong>Purpose: </strong>As the use of robotic platforms for inguinal hernia repairs continues to grow, the rTAPP (Robotic Trans-Abdominal Pre-Peritoneal) approach is being performed significantly more often than rTEP (Robotic Totally Extra-Peritoneal) and is predominantly taught to newly trained robotic surgeons. This study's primary objective was to evaluate the feasibility of a proposed modified rTEP technique that incorporates balloon dissection as a primary tool, enabling the horizontal placement of three trocars aligned with the umbilicus. Secondary objectives included evaluation of safety and effectiveness of this technique, and of the learning curve required to reach proficiency.</p><p><strong>Methods: </strong>From February 2023 to April 2024, a total of 97 consecutive patients (87 males, 10 females) with an average age of 61 years (range 17-89) and a mean body mass index of 26 kg/m² (21-37) underwent rTEP for the repair of 122 inguinal and femoral hernias. All procedures were performed by a single surgeon following a standardized protocol detailed in this manuscript. Key metrics and events assessed included conversions to open or laparoscopic approaches, console operating times, postoperative narcotic usage, postoperative complications, serious adverse events, unplanned returns to the operating room within 30 days, and hernia recurrences. Cumulative sum (CUSUM)_sequential analysis was used for determination of the learning curve.</p><p><strong>Results: </strong>Repaired hernias included 57 indirect (46.7%), 48 direct (39.3%), 4 femoral (3.3%) and 13 mixed (10.7%). There were no conversions to open or laparoscopic surgery, and the average console time was 45 min for unilateral repairs and 68 min for bilateral repairs. 70% of patients elected not to use the narcotic prescribed for postoperative analgesia. There was one serious adverse event (1/97, 1.0%), and one unplanned return to the operating room within 30 days (1/97, 1.0%). Over an average follow-up period of 52 weeks (range 25-87 weeks), there was one recurrence (1/122, 0.8%). In our analysis of the learning curve, we found that proficiency was reached around the 24th non-complex unilateral case.</p><p><strong>Conclusion: </strong>The modified rTEP technique utilizing balloon dissection is feasible, reproducible and time efficient. This study demonstrates its safety and effectiveness. The technique provides superior visualization of the extraperitoneal space, facilitates manipulation of robotic wristed instruments, and ensures proper mesh placement. Early postoperative outcomes suggest that rTEP could play an important role in the surgical management of inguinal and femoral hernias. Further studies are needed to provide data on short and long-term quality of life, and to compare rTEP to rTAPP.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"115"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614800","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":"The sagitta in 3D reconstruction of linea alba on routine CT scans is predictive of postoperative burst abdomen.","authors":"Matthias Mehdorn, Benedikt Schnarkowski, Sigmar Stelzner, Uwe Scheuermann, Woubet Tefera Kassahun, Timm Denecke, Stefan Niebisch, Hans-Jonas Meyer","doi":"10.1007/s10029-025-03303-0","DOIUrl":"10.1007/s10029-025-03303-0","url":null,"abstract":"<p><strong>Purpose: </strong>Burst abdomen (BA) is a relevant complication after abdominal surgery that causes additional surgical procedures, prolonged hospital stays and long-term morbidity. Several underlying risk factors exist and have been characterized previously. Those risk factors consist of surgical and medical factors. Recently, CT-derived body composition is of rising interest and 3D reconstruction of the linea alba has been studied. The clinical significance of those parameters is not clear. We therefore performed an analysis of linea alba 3D reconstruction measurements and their prognostic significance on the development of BA.</p><p><strong>Methods: </strong>An institutional data base of patients with post operative wound infections was assembled. The subgroup of patients with BA was compared to controls. If the patients had complete preoperative abdominal CT scans, their images were further analyzed and 3D reconstruction of the linea alba was performed. Subsequently, lineal alba was measured at predetermined positions. Those values were evaluated as risk factors for postoperative BA.</p><p><strong>Results: </strong>A total of 72 patients with BA and 32 controls were eligible for the analysis. We found body mass index-related significant differences as well as sex related differences in linea alba width. Furthermore, BA patients had a significantly wider linea alba and longer sagitta compared to controls. In the multivariate analysis of linea alba measurements and clinical parameters, the length of the sagitta was significantly associated with the risk of BA (OR 1.266; 95% CI 1.011-1.585; p = 0.04).</p><p><strong>Conclusion: </strong>In this study of 3D reconstruction of the linea alba from routine CT scans, we could show that a longer sagitta was associated with an increased risk of postoperative BA.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"117"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604722","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":"Incidence and clinical characteristics of occult inguinal hernias: a retrospective analysis of laparoscopic repair.","authors":"Yansheng Zheng, Yuling Xue, Keling Li, Zhe Zhang, Zhenhui Wan, Haipeng Huang, Wenjun Xiong, Jin Li","doi":"10.1007/s10029-025-03298-8","DOIUrl":"https://doi.org/10.1007/s10029-025-03298-8","url":null,"abstract":"<p><strong>Background: </strong>Occult inguinal hernia is a unique clinical challenge characterized by asymptomatic presentation and the absence of detectable signs on physical examination, leading to frequent misdiagnosis and underdiagnosis. The advancement of laparoscopic hernia surgery has facilitated the identification of occult hernias, yet effective diagnostic and predictive methods remain lacking.</p><p><strong>Objective: </strong>This study aims to evaluate the incidence and clinical characteristics of occult inguinal hernias detected during laparoscopic unilateral inguinal hernia repair and to provide evidence-based recommendations for their management.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 868 patients diagnosed preoperatively with unilateral inguinal hernia at the Guangdong Provincial Hospital of Traditional Chinese Medicine between January 2013 and December 2020. All patients underwent laparoscopic hernia repair surgery, during which both sides of the inguinal area were explored for occult hernias. Statistical analysis, including univariate and multivariate logistic regression, was performed to identify significant predictors of occult hernias.</p><p><strong>Results: </strong>Intraoperative detection of occult inguinal hernias was observed in 225 patients (25.92%). Patients with occult inguinal hernia had a higher median age of 68 (59, 76) years, compared to 63 (52, 73) years for those with unilateral inguinal hernia. The incidence was notably higher in females (34.61%) compared to males (25.37%). Stratified by hernia type, the prevalence of occult hernias was 23.84% among patients with indirect hernias (154/646) and 31.75% among those with direct hernias (60/189). Among the 225 patients with occult hernias, 129(57.33%) occult hernias cases occurred on the left side, and 142(63.11%) occult hernias cases were of the indirect type. Multivariate logistic regression analysis identified female gender, high age, and the presence of high-risk factors for intra-abdominal hypertension as independent and significant predictors of occult hernia development.</p><p><strong>Conclusion: </strong>Occult inguinal hernia remains a diagnostic and therapeutic challenge. For older patients presenting with unilateral inguinal hernia and high-risk factors for intra-abdominal hypertension, we recommend TAPP exploration and simultaneous repair of contralateral occult hernias.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"111"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604721","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 quadratus lumborum blocks for pain control after open abdominal wall reconstruction: a single institution retrospective analysis.","authors":"Sarah Budney, Eric Middleton, Kyle Kleppe, Matthew Mancini, Gregory Mancini, Melissa Phillips, Catherine McKnight, John Griepentrog, Aldo Fafaj, Kaela E Blake","doi":"10.1007/s10029-025-03296-w","DOIUrl":"https://doi.org/10.1007/s10029-025-03296-w","url":null,"abstract":"<p><strong>Introduction: </strong>Abdominal wall reconstruction (AWR) is associated with significant post-operative pain for which there is no standardized treatment regimen. Quadratus lumborum (QL) blocks have not been studied in open ventral hernia repair. This study reviews our institution's experience with QL blocks in open AWR.</p><p><strong>Methods: </strong>A retrospective review from October 2022 to October 2024 was completed. Patients undergoing elective, open abdominal wall reconstruction who received pre-operative QL blocks were included. Variables analyzed included patient demographics, comorbidities, operative technique, mesh type, daily opioid consumption reported as morphine milliequivalents (MMEs), and length of stay. The primary outcome was MMEs consumed in the first 24 h after surgery.</p><p><strong>Results: </strong>There were 102 patients included in the study. The first 24-hour median opioid MME consumption was 8 (IQR 0-67.5). The median MMEs peaked on day 2 at 47 (IQR 30-114) and then trended down each day. The median length of stay was 4.3 days (IQR 4.1-5.9). There were no complications related to the QL block procedure.</p><p><strong>Conclusion: </strong>This is the first study to report on post-operative opioid consumption in patients receiving a quadratus lumborum block prior to open ventral hernia repair. We found patients consumed minimal MMEs in the first 24 h after surgery suggesting that QL blocks may provide analgesic benefit in abdominal wall reconstruction.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"118"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614397","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":"Transversus abdominis plane (TAP) block for postoperative pain management after ventral hernia repair: an updated systematic review and meta-analysis.","authors":"Ana Caroline D Rasador, Carlos A Balthazar da Silveira, Natália P Pereira, Raquel Nogueira, Flavio Malcher, Diego Laurentino Lima","doi":"10.1007/s10029-025-03305-y","DOIUrl":"https://doi.org/10.1007/s10029-025-03305-y","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain remains a common concern following ventral hernia repair (VHR), especially for open procedures. We aim to assess the effectiveness of the Transversus Abdominis Plane (TAP) block for the management of postoperative pain following VHR.</p><p><strong>Methods: </strong>Cochrane, EMBASE, and PubMED, MEDLINE, and Web of Science were systematically searched for studies comprising adults undergoing VHR with preoperative TAP block, compared to placebo and epidural analgesia. The outcomes selected for analysis were postoperative pain with the numeric rating scale (NRS), postoperative morphine milligram equivalents (MME) per day, and hospital length of stay (LOS). Subgroup analysis was performed for studies using the Liposomal Bupivacaine (Exparel^®) for TAP block.</p><p><strong>Results: </strong>1,460 results were screened, and 14 included, comprising 9 retrospective cohort studies and 5 RCTs, totaling 1,617 patients. TAP block was associated with a shorter LOS compared to conventional pain measures (MD -1,14 days; 95% CI -2.05, -0.22; P = 0.014) and to epidural analgesia (MD -2.02 days; 95% CI -2.67, -1.37; P < 0.001), and lower NRS scale in the day of surgery (MD -1.24; 95% CI -1.81, -0.68; P < 0.001) and in the POD1 (MD -0.63; 95% CI -1.18, -0.08; P = 0.025) compared to placebo. No benefit was seen for TAP block regarding opioid consumption compared to epidural analgesia and placebo. No differences were seen between TAP block and epidural analgesia for the NRS scores. Subgroup analysis of Exparel^® compared to simple bupivacaine showed no benefit for Exparel^®.</p><p><strong>Conclusions: </strong>The TAP block is associated with shorter LOS compared to placebo and epidural analgesia and is related to less early postoperative pain compared to the conventional pain measures. The TAP block should be considered as a pain management modality for VHR, however cost-effective analysis is required to address the feasibility of the routine utilization of this approach and to balance the financial benefits of its application.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"113"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604723","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}