Hernia最新文献

{"title":"A cross-sectional survey investigating surgeon perceptions of pre-operative risk prediction models incorporating radiomic features.","authors":"Jane N Ewing, Zachary Gala, Malia Voytik, Robyn B Broach, Jayaram K Udupa, Drew A Torigian, Yubing Tong, John P Fischer","doi":"10.1007/s10029-025-03292-0","DOIUrl":"10.1007/s10029-025-03292-0","url":null,"abstract":"<p><strong>Purpose: </strong>Incisional hernias are a significant source of morbidity in the United States that impact quality of life and can cause life-threatening complications. Complex patient factors, collected as structured and unstructured data, contribute to the risk of developing an incisional hernia following abdominal surgery. It is unknown how risk prediction models derived from imaging data, or radiomic features, can enhance pre-operative surgical planning. This study investigates surgeons' perspectives regarding risk prediction models derived from radiomic features and assesses the model's impact on surgeon behavior.</p><p><strong>Methods: </strong>An online cross-sectional survey assessing perceptions of a pre-operative risk prediction model was administered to surgeons across the US from April 23, 2024- May 30, 2024. Surgeons' beliefs of the risk model's impact on surgeon behavior and its applicability in the clinical setting were assessed.</p><p><strong>Results: </strong>A total of 166 completed surveys were analyzed. Mean age was 52.3 (SD 10.1), 71.1% were male, 78.9% were White, and 90.4% were not Hispanic or Latino. The majority of the respondents were general surgeons (58%), colorectal surgeons (14%), thoracic surgeons (12%), and urologists (7%). The mean level of accuracy predicted from radiomic features needed to prompt a change in management was 74.5% (SD 15.1%). The mean at which FPR and FNR were unacceptable was 25.9% (SD 16.9%) and 26.1% (SD 21.7%), respectively. Most believed a risk prediction model tool would improve their peri-operative management.</p><p><strong>Conclusion: </strong>A majority of surgeons were positively supportive of incorporating a hernia risk-prediction clinical decision tool incorporating radiomic features in their clinical practice.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"97"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448956","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":"Preoperative botulinum toxin for complex abdominal wall reconstruction: a meta-analysis of propensity-score matched studies with trial sequential analysis.","authors":"Cynthia Florencio de Mesquita, Enrico Prajiante Bertolino, Amanda Godoi, Augusto Graziani E Sousa, Stalin Isaias Canizares Quisiguina, Sergio Mazzola Poli de Figueiredo","doi":"10.1007/s10029-025-03287-x","DOIUrl":"10.1007/s10029-025-03287-x","url":null,"abstract":"<p><strong>Purpose: </strong>Large ventral hernias can be associated with significant loss of domain, and preoperative Botulinum Toxin A (BTA) has been suggested as an adjunct therapy to minimize the effects of ventral hernia repair and facilitate fascial closure. However, there is often bias in studies involving BTA and its use is associated with significant cost and its efficacy remains unclear.</p><p><strong>Methods: </strong>We systematically searched Medline, Embase, Cochrane, and ClinicalTrial.gov for propensity-score matched (PSM) studies comparing preoperative BTA and AWR with standard AWR for complex hernias. We pooled odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) to assess outcomes, applying a random-effects model. We used R studio version 4.3.1 for statistical analyses.</p><p><strong>Results: </strong>We included six studies with PSM comprising 851 patients undergoing AWR. The mean age was 60.5 years, mean BMI was 31.8 kg/m², and 46.5% of patients were male. There were no significant differences between groups regarding fascial closure rate (OR 1.54; 95% CI 0.78 to 3.05; p = 0.21), hernia recurrence (OR 0.81; 95% CI 0.33 to 2.01; p = 0.65), component separation (OR 1.50; 95% CI 0.54 to 4.14 p = 0.4), surgical site infections and occurrences (OR 1.31; 95% CI 0.34 to 5.00; p = 0.70), length of hospital stay, or operation time. The Trial Sequential Analysis (TSA) indicated that none of the outcomes reached the necessary sample size for a definitive conclusion.</p><p><strong>Conclusions: </strong>Preoperative BTA did not offer significant benefits in AWR of complex incisional hernia repairs. However, TSA showed that the required sample size was not achieved.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"101"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448364","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":"Laparoscopic perineal hernia repair after abdominoperineal resection.","authors":"Xin Yuan, Yi Lin Zhu, Xue Fei Zhao, Jie Chen","doi":"10.1007/s10029-025-03288-w","DOIUrl":"10.1007/s10029-025-03288-w","url":null,"abstract":"<p><strong>Purpose: </strong>Perineal hernia(PH) is a complication after abdominoperineal resection(APR), which is a special kind of incisional hernia, lacking consensus about treatment. This study is aimed at the effect of laparoscopic repair with mesh.</p><p><strong>Methods: </strong>A retrospective study was conducted from Januarary 1st 2015 to December 31st 2023 for the patients undergoing laparoscopic perineal hernia repair after abdominoperineal resection(APR). The data of characteristics, surgery details and follow-up were collected and analysed to evaluate the effect and complications.</p><p><strong>Results: </strong>41 cases were included altogether and all patients received laparoscopy approach, 14 males and 27 females, median age was 70 years(range 45-80years), the mean BMI was 25.04 ± 3.38 kg/m². Operations were completed under laparoscopy in 22 cases, combined with open surgery in 19 cases. 40 cases were treated with synthetic mesh and 1 case with biological mesh. The median operative time was 145 min(range 55-270 min), and the post operative hospital day was 13 days(range 4-47 days). The median follow-up time was 30 months(range 6-103months). There were 2 cases of wound infection and 1 case of intestinal obstruction after operation during in hospital days. 1 cases of recurrence and 2 cases of abnormal sensation in the operation area were observed during the follow-up period. The total incidence of complications was 14.6%.</p><p><strong>Conclusion: </strong>Laparoscopic perineal hernia repair with mesh shows low rates of complications, which is a safe and effective method to perineal hernia after APR. For large defects, hybrid technique helps to close the defect and eliminate dead spaces. The appropriate kind and adequate mesh overlap are critical. Short-term follow up shows positive outcomes in this retrospective study and the controlled trial and long-term follow-up is needed in the future.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"103"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448868","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":"Systematic review and meta-analysis on robotic assisted ventral hernia repair: the ROVER review.","authors":"Sara Capoccia Giovannini, Maaike Vierstraete, M Frascio, G Camerini, F Muysoms, C Stabilini","doi":"10.1007/s10029-025-03274-2","DOIUrl":"10.1007/s10029-025-03274-2","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic surgery for ventral hernia repair (VHR) is gaining attention for its potential advantages over laparoscopic and open techniques. This approach combines the advantages of minimally invasive surgery with the ability to perform technically challenging procedures, often required in open surgery but difficult with conventional laparoscopy. We aim to evaluate the efficacy and safety of robotic VHR compared to other surgical approaches, focusing on postoperative complications, operative time, and costs.</p><p><strong>Material and methods: </strong>A systematic review with meta-analysis were conducted, including 67 studies from January 2010 to May 2023 on Robotic VHR compared with other techniques. Primary outcome was 30-days postoperative complications; SSI, SSO, seroma, mortality, recurrence, length of hospital stay, operative time and costs were analysed as secondary outcomes.</p><p><strong>Results: </strong>Robotic surgery was associated with longer operative times compared to both laparoscopic (MD 64.67 min; p < 0.001) and open repairs (MD 69.69 min; p < 0.001). However, it resulted, compared to open surgery, in fewer SSIs (OR 0.62; p 0.05), mortality (OR 0.44; p 0.04) and shorter hospital stay (MD -3.77 days; p < 0.001). No differences were found in overall complications or length of stay between robotic and laparoscopic approaches but higher costs and longer operative times were reported in robotic VHR.</p><p><strong>Conclusions: </strong>Based on the currently available low-quality evidence, robotic VHR appears to offer limited advantages compared to laparoscopic techniques. However, when compared to open approaches, robotic VHR may demonstrate reduced postoperative complications and shorter hospital stays even if an higher rate of seroma formation was retrieved probably related to technical details. Nevertheless, longer operative times and higher costs remain significant limitations. Further high-quality comparative studies are warranted to assess long-term outcomes and cost-effectiveness.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"95"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448654","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":"Postoperative outcomes and wound events in incisional hernia repair using hybrid mesh: results from a prospective multicenter italian study.","authors":"Francesco Pizza, Antonio Iuppa, Pietro Maida, Vincenzo Pilone, Antonio Crucitti, Tomaiuolo Pasquina Maria Carmen, Lorenzo Morini, Jacopo Nicoló Marin, Tommaso Petitti, Camillo Bertoglio, Gianpaolo Marte, Ignazio Sordelli, Simona Gili, Francesco Saverio Lucido, Lugi Busciano, Dario D'Antonio, Ludovico Docimo, Claudio Gambardella","doi":"10.1007/s10029-025-03285-z","DOIUrl":"10.1007/s10029-025-03285-z","url":null,"abstract":"<p><strong>Purpose: </strong>The complexity of managing ventral hernias leads surgeons to explore different optimal techniques and mesh selection. Hybrid meshes, combining absorbable and permanent components, aim to balance long-term durability and infection risk. This study evaluated the extended-term outcomes of GORE^® SYNECOR intraperitoneal (IP) biomaterial for incisional hernia repair through minimally invasive laparoscopic techniques.</p><p><strong>Methods: </strong>Conducted across eight Italian surgery centers from January 2020 to September 2022, this multicenter analysis prospectively assessed the outcomes of patients undergoing laparoscopic repair of incisional hernias using GORE® SYNECOR. Outcomes included postoperative wound events, pain, recurrence, and mesh bulging.</p><p><strong>Results: </strong>A total of 371 patients participated in the study. No serious adverse events or significant mesh-related complications were observed. Surgical site occurrences (SSO) were recorded in a proportion of cases, and hernia sac volume was identified as the only independent risk factor (p < 0.0001). At three months post-surgery, pain levels and impacts on daily activities were minimal. At 24 months, recurrence and mesh bulging were associated only with patients with hernia sac sizes larger than 450 cm³.</p><p><strong>Conclusion: </strong>Laparoscopic incisional hernia repair using GORE^® SYNECOR hybrid mesh demonstrated satisfactory safety and efficacy regarding wound-related events and recurrence. Minor complications were more closely related to hernia sac size rather than the surgical approach, suggesting that the laparoscopic technique may optimize outcomes, particularly in elderly, smokers, and overweight patients.</p><p><strong>Clinicaltrials: </strong>NCT06166069.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"94"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447630","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":"Preoperative Botulinum Toxin A (BTA) injection in abdominal wall reconstruction for subxiphoid (M1) hernias.","authors":"Monica E Polcz, Alexis M Holland, William R Lorenz, Sullivan Ayuso, Gregory T Scarola, Dau Ku, Vedra A Augenstein, B Todd Heniford","doi":"10.1007/s10029-025-03290-2","DOIUrl":"10.1007/s10029-025-03290-2","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative BTA assists with fascial closure during abdominal wall reconstruction. Its efficacy in subxiphoid (M1) hernias has been questioned with high rates of component separation techniques (CST) despite BTA. To assess the role of BTA in these hernias, we compared fascial closure and recurrence rates in patients with M1 hernias requiring CST with or without preoperative BTA.</p><p><strong>Methods: </strong>A prospectively maintained database at a tertiary hernia center was reviewed for M1 hernias who underwent CST, and grouped based on use of preoperative BTA. Standard univariate analysis was performed.</p><p><strong>Results: </strong>Of 67 patients, 30 (44.8%) received preoperative BTA. BTA versus non-BTA groups had similar mean ages (56.0 ± 14.1vs.61.5 ± 11.8 years, p = 0.087), ASA score (p = 0.345), rate of diabetes (p = 0.421), and very large defect size (499.2 ± 185.5vs.416.1 ± 238.6 cm2,p = 0.144). In the BTA group, BMI was lower (28.9 ± 5.1vs.32.7 ± 7.2 kg/m2,p = 0.018), with fewer current smokers (0%vs.10.8%,p = 0.006), and more contaminated (20.0%vs.5.4%) and dirty cases (33.3%vs.13.5%) (p = 0.008). External oblique release was performed in 24 (80.0%) BTA patients versus 23 (62.2%) non-BTA (p = 0.179), posterior CST in 6 (20.0%) versus 14 (37.8%) (p = 0.133). Rates of bilateral CST (90.0%vs.94.6% p = 0.394), fascial closure (90.0%vs.94.6%,p = 0.650), overall wound complications (33.3%vs.43.2%,p = 0.458), and recurrence (6.7%vs.2.7%,p = 0.583) were similar with average follow up of 12.7 ± 18.8 versus 24.1 ± 28.2 months (p = 0.062).</p><p><strong>Conclusion: </strong>Repair of very large M1 hernias requires high rates of CST despite preoperative BTA injection. When CST is needed, BTA as a preoperative adjunct does not appear to offer benefit in terms of fascial closure rates, frequency of bilateral CST, or risk of recurrence.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"96"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448233","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":"Does sarcopenia have a negative impact on the efficacy of botulinum toxin A in the prehabilitation of patients undergoing incisional hernia repair? A multicentric retrospective study.","authors":"Aurélien Villemin, Théophile Delorme, Pablo Ortega-Deballon, Hessa Alsuwaidan, David Moszkowicz, Benoit Romain","doi":"10.1007/s10029-025-03291-1","DOIUrl":"10.1007/s10029-025-03291-1","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin A (BTA) injections are increasingly used to prepare patients undergoing surgery for incisional hernias larger than 10 cm. The aim of this study was to analyze the impact of sarcopenia on the efficacy of BTA injection in lengthening the lateral abdominal muscles.</p><p><strong>Methods: </strong>Between August 2018 and January 2024, patients with midline incisional hernias ≥ 10 cm undergoing preoperative BTA injections were included in a multicentric database. Sarcopenia was evaluated calculating the muscle area measured on a transverse CT scan at the level of the L3 lumbar vertebra. Muscle characteristics and the volumes of the incisional hernia and abdominal cavity were compared before and 4 to 6 weeks after BTA injection. The effect of BTA on muscle elongation was evaluated according to sarcopenia.</p><p><strong>Results: </strong>Fifty-nine patients were included. Sarcopenia did not impair the efficacy of BTA in terms of length of the lateral abdominal wall muscles, with a 1.8 cm increase bilaterally in each group. Regarding the efficacy of BTA injection, 80% of patients experienced elongation of the lateral abdominal wall muscles. Failure of the injection therefore affected 20% of patients. These results were similar in both groups, regardless of sarcopenia. Analysis of the characteristics of 'responders' and 'nonresponders' revealed that 'nonresponders' had a greater length of the lateral abdominal wall muscles on the scan prior to BTA injection, likely due to less significant muscle retraction.</p><p><strong>Conclusion: </strong>Sarcopenia did not impair the effectiveness of BTA in terms of elongation prior to incisional hernia repair.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"104"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448866","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":"Penetrating fixation device versus fibrin sealant for mesh fixation in laparoscopic repair of ventral hernia: a randomized controlled trial.","authors":"Hemanga Kumar Bhattacharjee, Vishal Anand, Mithun Nk, Ashwani Kumar Mishra, Aditya Baksi, Mohit Joshi, Suhani, Rajinder Parshad","doi":"10.1007/s10029-025-03294-y","DOIUrl":"10.1007/s10029-025-03294-y","url":null,"abstract":"<p><strong>Purpose: </strong>Post-operative pain following intra peritoneal onlay mesh (IPOM) repair of ventral hernia is commonly attributed to mechanical fixation devices. Fibrin sealant is a novel technique of mesh fixation purported to cause less pain. The aim of this study was to compare postoperative pain in these two methods of mesh fixation.</p><p><strong>Methods: </strong>This was a double-blinded, randomized controlled trial. Eighty patients with primary ventral hernia underwent laparoscopic IPOM repair using PROCEED™ mesh, which was fixed with either mechanical fixation device, SECURESTRAP™ (MF group) or fibrin sealant, TISSEEL™ (FS group). Primary end point was postoperative pain at rest and movement on a Visual Analogue Scale (VAS) of 0-10. Operative time, recurrence, seroma and quality of life (QoL) were secondary outcomes. Patients were followed up for one year.</p><p><strong>Results: </strong>There was no significant difference in pain score at 12 h, 24 h, 7 days, 1, 3 and 12 months between the groups, except pain on movement, which was significantly less in the FS group on the seventh day (median VAS 3 vs. 2, p = 0.01). Mean operative time was 8 min longer in the FS group (p = 0.001). Two patients in the FS and none in the MF group had recurrence at one year (p = 0.18). Seroma formation, postoperative QoL and patient satisfaction scores were similar in both groups.</p><p><strong>Conclusions: </strong>Use of fibrin sealant for mesh fixation does not provide significant advantage over mechanical fixation in laparoscopic IPOM repair.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"98"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448983","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":"Transabdominal Preperitoneal (TAPP) versus intraperitoneal onlay Mesh (IPOM) for ventral hernia repair - an updated systematic review and meta-analysis.","authors":"Ana Caroline D Rasador, Carlos A Balthazar da Silveira, Conrad Ballecer, Sergio Mazzola Poli de Figueiredo","doi":"10.1007/s10029-025-03271-5","DOIUrl":"10.1007/s10029-025-03271-5","url":null,"abstract":"<p><strong>Background: </strong>Persistent controversy exists regarding the optimal approach for ventral hernia repair (VHR). Considering the concerns regarding the use of intraperitoneal mesh and the increasing use of robotic technology, transabdominal preperitoneal (TAPP) is increasingly being performed. This study aims to compare TAPP and intraperitoneal onlay mesh (IPOM) for VHR.</p><p><strong>Methods: </strong>PubMED, Cochrane, and EMBASE databases were systematically searched from inception to April 2024, for studies on patients undergoing VHR, comparing TAPP and IPOM. Outcomes included were intraoperative complications, such as vascular and bowel injury, and postoperative complications (hernia recurrence within 1 year of operation, seroma, hematoma, ileus, urinary retention, small bowel obstruction). Additional outcomes were hospital length of stay (LOS), operative time, and visual analog scale (VAS) scores after 24 h of surgery.</p><p><strong>Results: </strong>From 398 records, 8 were included in our pooled analysis, which comprised 7 retrospective cohorts and 1 prospective cohort, totaling 952 patients. 458 (48%) patients underwent laparoscopic VHR and 494 (52%) underwent robotic VHR. Our meta-analysis revealed that TAPP is associated with a lower incidence of overall postoperative complications as a composite outcome (13.9% vs 23.9%; RR 0.66; 95% CI 0.48, 0.92; P = 0.013). After performing a subgroup analysis for robotic surgeries only, we found that TAPP also has a lower rate of urinary retention (RR 0.12; 95% CI 0.02, 0.99; P = 0.049) and hematoma compared to IPOM (RR 0.20; 95% CI 0.04, 0.95; P = 0.043). No differences were seen between both techniques regarding ileus, hernia recurrence, operative time, seroma, small bowel obstruction, vascular injury, and bowel injury. Subgroup analysis for robotic VHR showed similar results. After performing a leave-one-out sensitivity analysis, we also obtained a shorter hospital LOS (MD  - 0.56 days; 95% CI  - 0.86,  - 0.25; p < 0.05) and VAS scores within 24 h of surgery (MD  - 1.04; 95% CI  - 1.61,  - 0.47; p < 0.05) for the TAPP technique.</p><p><strong>Conclusions: </strong>IPOM is associated with a higher incidence of hematoma, urinary retention, overall early postoperative complications, and potentially longer hospital LOS and higher VAS pain scores within 24 h compared to TAPP. Therefore, the TAPP should be the technique of choice for minimally invasive VHR when feasible; however, considering the availability of resources and surgeon expertise, IPOM might still be considered a viable alternative.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"93"},"PeriodicalIF":2.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424490","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":"Management of post-traumatic non-iatrogenic lumbar/flank hernias: diagnosis and treatment options-systematic review, meta-analysis and management algorithm.","authors":"Abdulaziz Elemosho, Jeffrey E Janis","doi":"10.1007/s10029-025-03281-3","DOIUrl":"10.1007/s10029-025-03281-3","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic non-iatrogenic lumbar/flank hernias (LFH) represent a unique and important subset of abdominal wall hernias that can develop following either blunt or penetrating trauma to the abdomen. There is paucity of evidence guiding the management and identification of associated complications of this hernia type in the literature. We aim to pool available cases in the literature and summarize the diagnostic and management approaches of traumatic LFH.</p><p><strong>Methods: </strong>PUBMED, EMBASE and Scopus databases were queried, and relevant articles were selected following PRISMA guideline for systematic reviews. Studies in English and with complete data on post-traumatic non-iatrogenic LFH, including case reports, were included.</p><p><strong>Results: </strong>A total of 211 cases of post-traumatic non-iatrogenic lumbar/flank hernias (LFH) from 62 articles published between 1993 and 2023 were included, with mean age of 52.1 years (interquartile range IQR: 25.8-62.7 years). Most patients had CT-confirmed diagnosis (96.1%), had inferiorly located LFHs (86.8%), and fell into Type B Moreno-Egea class (74.6%). Flank pain was the commonest presenting complaint (13.4%) with flank hematoma present at presentation in 8.6% of the cohort. Post-traumatic non-iatrogenic LFHs were diagnosed at index hospitalization/presentation in 75.5% and repaired during the same admission in 48.2% of patients. Open repair with mesh was the most common method of repair (59.8%), followed by open repair without mesh in 28.7% and by minimally invasive laparoscopic approach in 11.5% cases. Overall recurrence rate (for all repair types) was 8% at mean follow up of 15.4 months (IQR: 12.5-25.0 months). Hernia defect size of ≥ 8 cm was 100% sensitive and 52.9% specific for the prediction of mesenteric injuries. Flank hematoma/seatbelt sign was 100% sensitive and 81.8% specific for the prediction of mesenteric injuries in traumatic LFHs.</p><p><strong>Conclusions: </strong>Patients presenting with flank pain and flank hematoma following a blunt abdominal wall trauma should receive a thorough radiologic evaluation, particularly a CT scan, for post-traumatic non-iatrogenic LFHs. Complications such as mesenteric avulsion must be considered with high suspicion in patients whose hernia is associated with flank hematoma or with hernia diameter ≥ 8 cm. Long term follow-up after repair still requires further study. Open repair with extraperitoneal mesh reinforcement is the standard of care for hernias ≥ 8 cm repaired acutely or electively, and minimally invasive laparoscopic approach is typically utilized for hernias < 8 cm.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"92"},"PeriodicalIF":2.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412940","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}