Hernia最新文献

{"title":"Ventral ETEP, results of our experience after exceeding 150 cases. Operative outcomes and learning curve.","authors":"Digby Aylen Montechiari, Micaela Milagros Rossi, Maria Belen Soria, Alejandro Rossini, Franco José Signorini","doi":"10.1007/s10029-025-03345-4","DOIUrl":"https://doi.org/10.1007/s10029-025-03345-4","url":null,"abstract":"<p><strong>Purpose: </strong>Laparoscopic repair of ventral hernias has evolved significantly. The enhanced-view totally extraperitoneal (eTEP) technique, which places the mesh in a retromuscular plane, has emerged as an alternative to traditional open and laparoscopic approaches, particularly in patients with associated diastasis recti. This study evaluates the efficacy and safety of eTEP in patients with ventral hernias and diastasis recti.</p><p><strong>Methods: </strong>A retrospective study was conducted on patients who underwent eTEP for ventral hernia repair at a university hospital between January 2019 and September 2024. Demographic data, hernia characteristics, operative time, postoperative complications, and recurrence were collected. Furthermore, the learning curve for ventral hernia repairs was assessed using the CUSUM statistical method.</p><p><strong>Results: </strong>163 patients underwent eTEP for ventral hernias. The majority were male (50.3%) with a mean age of 53.5 years. Primary hernias were most common (77.3%), and diastasis recti was present in 82.8% of cases. The mean operative time was 137.2 min. Conversions to open surgery represented 2.5%. The most common postoperative complications were seromas (6.7%) and wound infections (3.1%). The long-term recurrence rate was 0.6%. The average follow-up duration was 15.3 ± 21.3 months. The learning curve for eTEP in umbilical hernia repair was established after performing 14 cases.</p><p><strong>Conclusions: </strong>eTEP has proven to be a safe and effective technique for ventral hernias, with a seroma incidence of 6.7%, a recurrence rate of 0.6%, and a learning curve of 14 cases.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"208"},"PeriodicalIF":2.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325531","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":"Using the Alfapump® to control ascites enabling elective umbilical hernia repair: A case report.","authors":"Natasha A Sioda, Hugo E Vargas, Jill L Weidknecht, Kristi L Harold","doi":"10.1007/s10029-025-03393-w","DOIUrl":"https://doi.org/10.1007/s10029-025-03393-w","url":null,"abstract":"<p><strong>Purpose: </strong>Umbilical hernia repair in patients with medically refractory ascites poses a significant challenge for clinicians. Optimization of ascites prior to surgical intervention is recommended due to improved post-operative outcomes. The alfapump® is a battery-operated device that directs ascites into the bladder for excretion and can be utilized in patients with medically refractory ascites. We present a patient with medically refractory ascites that underwent implantation of the alfapump® allowing for elective umbilical hernia repair.</p><p><strong>Methods: </strong>A 70-year-old male with medically refractory ascites in the setting of a recurrent symptomatic umbilical hernia underwent implantation of the alfapump®.</p><p><strong>Results: </strong>The patient was followed in the outpatient setting and maintained adequate control of his ascites following implantation of the alfapump® device. He subsequently underwent a robotic repair of his umbilical hernia. Post-operatively, the patient did not experience a recurrence or complications related to the hernia repair.</p><p><strong>Conclusion: </strong>Hernia repair in the setting of medically refractory ascites pose a challenge for surgeons. The implantation of the alfapump® may be a viable option to control medically refractory ascites allowing for elective hernia repair.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"209"},"PeriodicalIF":2.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325530","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":"Abdominal wall reconstruction in ventral hernia repair: do current models predict surgical site risk?","authors":"Zachary Gala, Mehdi S Lemdani, Dustin Crystal, Jane N Ewing, Robyn B Broach, John P Fischer, Stephen J Kovach","doi":"10.1007/s10029-025-03350-7","DOIUrl":"https://doi.org/10.1007/s10029-025-03350-7","url":null,"abstract":"<p><strong>Introduction: </strong>Complications from ventral hernia repair (VHR) pose a significant healthcare burden. Risk assessment and stratification models are thus incentivized to improve cost-effectiveness and patient outcomes. The Ventral Hernia Risk Score (VHRS) and Ventral Hernia Work Group Classification (VHWG) are metrics that attempt to stratify and predict surgical site infection (SSI) and surgical site occurrence (SSO) risk based on patient characteristics. Our study aims to evaluate these models and assess external validity.</p><p><strong>Methods: </strong>A retrospective review of all VHR procedures between October 2013 - August 2022 performed by the senior authors was conducted. Demographic, comorbidity, perioperative and outcome-related information was collected. Non-SSI and non-SSO cohorts were compared to SSI and SSO cohorts respectively to assess possible significant differences in patient demographics and operative characteristics. The VHRS and VHWG models were applied to each patient to predict risk. The Youden index of the respective Receiver Operating Characteristic (ROC) curves defined optimal score cutoffs for both models. Area under curve (AUC) was reported to assess model prediction quality.</p><p><strong>Results: </strong>A total of 1,414 patients who underwent VHR was identified, of which 175 (12.4%) experienced SSI and 367 (26.0%) SSO. Mean follow-up was 1.72 years [30 days, 13.65 years]. Patient demographics were similar between both non-SSI and SSI as well as non-SSO and SSO cohorts. However, comorbidities including prior non-VHR abdominal surgery (SSI: p < 0.001; SSO: p < 0.001), prior-VHR (SSI: p = 0.001; SSO: p-0.012), and prior mesh infection (p = 0.004) were significant between non-SSI and SSI cohorts as well as non-SSO and SSO cohorts. Operative characteristics including mesh plane (SSI: p = 0.008; SSO: p < 0.001) and adhesiolysis (SSI: p < 0.001; SSO: p < 0.001) were also significant in similar manner. Youden index of VHRS suggested a score of 7 as the optimal cutoff for increased SSI risk and 6 for SSO risk. The AUC was 0.609 for the VHRS-SSI model and 0.5882 for the VHRS-SSO model. VHWG grade of 3 was the optimal cutoff for both SSI and SSO. Model AUC was 0.616 for VHWG-SSI and 0.614 for VHWG-SSO.</p><p><strong>Conclusion: </strong>Our study presents the largest external validation cohort for assessing the VHRS model. The VHRS was not superior toc the VHWG for SSI or SSO prediction. While the VHRS was designed for simplicity and basis in obvious patient or operative characteristics, it fails to appropriately weight pre-operative measures and more holistically evaluate clinical factors. Both models have limited predictability and generalizability in patients undergoing ventral hernia repair.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"210"},"PeriodicalIF":2.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325529","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":"Correction to: Recurrence after implementation of an updated intraoperative protocol for totally extraperitoneal (TEP) inguinal hernia repair in a high-volume clinic - a retrospective cohort study.","authors":"R R Meuzelaar, A H W Schiphorst, J P J Burgmans","doi":"10.1007/s10029-025-03382-z","DOIUrl":"10.1007/s10029-025-03382-z","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"206"},"PeriodicalIF":2.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316811","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":"Acute inflammation triggered by two lightweight hernia meshes: a comparative in vitro and retrospective cohort study.","authors":"Martin Reichert, Bernadet Massambo, Anca-Laura Amati, Veronika Grau, Katrin Richter, Andreas Hecker","doi":"10.1007/s10029-025-03391-y","DOIUrl":"10.1007/s10029-025-03391-y","url":null,"abstract":"<p><strong>Purpose: </strong>Retro-muscular mesh augmentation is standard for repairing abdominal incisional or larger primary hernia. A wide variety of meshes with diverse properties are available. The knowledge on the immune-modulating effects of meshes is, however, insufficient. This study investigates the impact of two widely used lightweight meshes, ULTRAPRO^® and ProGrip™, on macrophage activation (in vitro), systemic inflammation (in vivo), patient perioperative and long-term outcomes.</p><p><strong>Methods: </strong>Human THP-1 cell-derived macrophages were cultured in absence and presence of ULTRAPRO^® or ProGrip™ meshes. The release of pro-inflammatory cytokines, interleukin (IL)-1β and IL-6, was measured following inflammasome activation. In a retrospective study, systemic inflammation and postoperative outcomes after retro-muscular hernia repair using ULTRAPRO^® (321 patients) or ProGrip™ (161 patients) meshes were analyzed.</p><p><strong>Results: </strong>In the presence of ULTRAPRO^®, IL-1β and IL-6 release by macrophages was increased, whereas ProGrip™ tended to reduce cytokine levels (p ≤ 0.05; n = 7). Baseline characteristics were comparable between both groups; systemic C-reactive protein levels were likewise higher in patients receiving ULTRAPRO^® compared to ProGrip™ (mean difference: 26.9 ± 7.5 mg/dl; p < 0.0001). No relevant differences were observed in perioperative morbidity or short-term outcomes, including complications and hospitalization after hernia repair, but hernia recurrence rates tended to be higher within three-year follow-up after ProGrip™ implantation compared to ULTRAPRO^® (p = 0.0630).</p><p><strong>Conclusion: </strong>Meshes exhibit distinct immune-modulating effects on macrophages, leading to differential activation that may influence foreign-body reaction and systemic inflammation. These immune responses potentially impact clinical outcomes and recurrence after hernia repair. This study underscores the need for comparative prospective, randomized-controlled trials to further evaluate the clinical relevance of mesh-specific immunological effects.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"205"},"PeriodicalIF":2.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316810","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":"A structured protocol for Preoperative Progressive Pneumoperitoneum (PPP) in Complex Abdominal Wall Reconstruction (CAWR): our York protocol.","authors":"Asim A Abbas, Anisah Ahmad, Alastair McCleary, Marcus Nicholls, Praminthra Chitsabesan, Srinivas Chintapatla","doi":"10.1007/s10029-025-03401-z","DOIUrl":"10.1007/s10029-025-03401-z","url":null,"abstract":"<p><strong>Background: </strong>Complex Abdominal Wall Reconstruction (CAWR) in patients with significant loss of domain poses substantial surgical and physiological challenges [1], [2]. Preoperative Progressive Pneumoperitoneum (PPP), involving incremental insufflation of gas into the abdominal cavity, enhances the likelihood of tension-free fascial closure [3]. However, there remains considerable variability and incompleteness in existing PPP protocols, especially concerning venous thromboembolism (VTE) prophylaxis, inferior vena cava (IVC) filter placement, respiratory prehabilitation, and multidisciplinary coordination.</p><p><strong>Methods: </strong>A structured literature review was conducted (MEDLINE® and Embase®, final search April 2025), yielding no comprehensive PPP protocols for CAWR. In response, we convened a multidisciplinary team at a tertiary UK referral centre-including specialists in general surgery, plastic and reconstructive surgery, vascular surgery, interventional radiology, and pharmacy-to develop an integrated, replicable protocol. Consensus development methods (CDMs) informed the iterative refinement process, incorporating clinical experience and best available evidence.</p><p><strong>Results: </strong>Our seven-week perioperative protocol systematically integrates key preoperative interventions: bilateral abdominal wall botulinum toxin injections, respiratory prehabilitation, abdominal binder use, VTE prophylaxis with low molecular weight heparin (LMWH), planned IVC filter insertion, peritoneal dialysis catheter placement, and scheduled PPP insufflation sessions. Final surgical planning is guided by crosssectional imaging obtained one week preoperatively. Postoperatively, a structured IVC filter removal strategy, including cavogram assessment, is implemented to manage thromboembolic risk.</p><p><strong>Conclusion: </strong>We present a comprehensive PPP protocol designed to optimise outcomes in CAWR. This structured, multidisciplinary approach represents an important step toward standardising care in complex abdominal wall reconstruction.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"207"},"PeriodicalIF":2.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316809","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":"Prevalence and risk factors of incisional hernia after ileostomy reversal: meta-analysis with meta-regression.","authors":"Salsabil Nasri, Neyrouz Kammoun, Mohamed Mehdi Trabelsi, Amine Ben Safta, Imen Samaali, Chadli Dziri, Ramzi Nouira","doi":"10.1007/s10029-025-03367-y","DOIUrl":"10.1007/s10029-025-03367-y","url":null,"abstract":"<p><strong>Background: </strong>The rate of incisional hernia (IH) at stoma site after ileostomy closure is controversial in the literature. We aimed to estimate the prevalence of IH at stoma site after ileostomy reversal and to determine its risk factors.</p><p><strong>Material and methods: </strong>We performed a systematic review according to PRISMA standards to identify studies reporting prevalence of IH after ileostomy closure. Meta-analysis was performed to estimate its rate. Heterogeneity was explained by meta-regression and subgroup analysis.</p><p><strong>Results: </strong>Twenty studies were included with 2629 patients. The pooled estimated rate was 13,7% with a 95% confidence interval (11-17%). The 95% prediction interval varied between 5,3% and 31,1%, which showed substantial heterogeneity. Meta-regression showed that ASA score III and IV increases IH rate (p = 0,02). Obese and elderly patients have a tendency for developing IH with substantial heterogeneity. Subgroup analysis for COPD, diabetes mellitus, smoking, laparotomy approach for the initial surgery, did not show statistically significant differences.</p><p><strong>Conclusion: </strong>Prevalence of IH is higher than previously estimated in the literature. ASA score III and IV increases its rate. Prospective randomized studies focusing on the impact of prophylactic mesh implementation are necessary.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"204"},"PeriodicalIF":2.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301981","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":"Correction to: A safety and effectiveness evaluation of RefluxStop in the treatment of acid reflux comparing large and small hiatal hernia groups: results from 99 patients in Switzerland with up to 4-years follow-up.","authors":"Yves Borbély, Dino Kroell, Sarah Gerber, Yannick Fringeli, Ioannis Linas, Joerg Zehetner","doi":"10.1007/s10029-025-03381-0","DOIUrl":"10.1007/s10029-025-03381-0","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"203"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274666","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":"Obesity-focused prehabilitation strategies in ventral hernia: Cohort study.","authors":"Víctor Rodrigues-Gonçalves, Mireia Verdaguer-Tremolosa, Pilar Martínez-López, Clara Nieto, Sana Khan, Manuel López-Cano","doi":"10.1007/s10029-025-03392-x","DOIUrl":"10.1007/s10029-025-03392-x","url":null,"abstract":"<p><strong>Purpose: </strong>Obesity increases the risk of complications and technical difficulty in ventral hernia repair. Preoperative weight loss is recommended to mitigate these risks, but the implementation of different strategies in routine practice remains poorly described. This study aimed to characterize the use of dietary counseling, pharmacotherapy, and bariatric surgery within a structured optimization pathway and provide preliminary insights into surgical outcomes in obese versus non-obese patients.</p><p><strong>Methods: </strong>In this retrospective, single-center study, obese patients with ventral hernia were managed with dietary counseling, pharmacotherapy, or bariatric surgery between April 2018 and April 2023. We evaluated implementation, weight loss achieved, eligibility for elective repair, and adherence. Surgical outcomes were descriptively analyzed in obese patients with and without preoperative weight loss and compared to non-obese patients.</p><p><strong>Results: </strong>Of 175 obese patients, 148 (84.6%) received dietary counseling, 15 (8.6%) pharmacotherapy, and 12 (6.8%) bariatric surgery. Median weight loss was highest after bariatric surgery (20.7%), followed by dietary counseling (4.6%) and pharmacotherapy (4.4%). Surgical eligibility rates were 83%, 44%, and 13%, respectively. Among 165 patients who underwent hernia repair, postoperative complications were more frequent in obese patients, regardless of preoperative weight loss, than in non-obese patients. Recurrence was numerically higher in patients without preoperative weight loss, though not statistically significant.</p><p><strong>Conclusion: </strong>A structured optimization pathway facilitated the use of diverse weight loss strategies before hernia repair in obese patients. Bariatric surgery achieved the greatest weight loss and eligibility. However, complications remained common, underscoring the need for individualized, multidisciplinary prehabilitation strategies.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"202"},"PeriodicalIF":2.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274667","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":"Ideal meshes, research, robotic surgery, and rethinking the ideal surgical space: back to the future.","authors":"Giampiero Campanelli","doi":"10.1007/s10029-025-03396-7","DOIUrl":"https://doi.org/10.1007/s10029-025-03396-7","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"201"},"PeriodicalIF":2.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233993","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}