Hernia最新文献

{"title":"Open versus laparoscopic inguinal hernia repair in patients with obesity: a NSQIP propensity-matched analysis of 59,943 elective, emergency, and recurrent cases.","authors":"Mary Hou, Philip Mitchell, Estifanos Debru, Neal Church, Daniel Meyer","doi":"10.1007/s10029-026-03751-2","DOIUrl":"https://doi.org/10.1007/s10029-026-03751-2","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic inguinal hernia repair is increasingly used as an alternative to open repair. Our study investigates the 30-day outcomes of open vs. laparoscopic inguinal hernia repair in the population with obesity using the National Surgical Quality Improvement Program (ACS-NSQIP) database.</p><p><strong>Methods: </strong>In this retrospective study, all patients with obesity who underwent inguinal hernia repair between the years 2015-2023 inclusive were selected from the ACS-NSQIP database. Patients who underwent open repair were matched with laparoscopic repair patients using propensity score. 30-day postoperative complication rates were compared between the open and laparoscopic groups including univariate and multivariate analysis. Subgroup analysis with emergency repair and recurrent hernia was conducted.</p><p><strong>Results: </strong>There were 59,943 patients included including 30,289 patients undergoing open repair and 29,654 undergoing laparoscopic repair. The ratio of laparoscopic to open cases increased overall during the study period. The multivariate analysis showed a decreased rate of serious complication (OR 0.17, 95%CI 0.04-0.79). Furthermore, the multivariate analysis demonstrated odds ratio of serious complication of 0.63 (95%CI 0.34-1.17) in emergency repairs and 0.21 (95%CI 0.10-0.44) in recurrent cases when compared to open approach.</p><p><strong>Conclusion: </strong>Laparoscopic inguinal hernia repair in patients with obesity demonstrated a lower rate of postoperative serious complications in the all-comers and recurrent repair subgroup and was comparable to open repair for the emergency surgery subgroup. This study further supports the safety of laparoscopic inguinal hernia repair as an alternative to open repair in patients with obesity.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251399","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":"Favorable one-year outcomes despite residual fascial tension after ventral hernia repair with transversus abdominis release.","authors":"Jay J W Han, William C Bennett, Jalen M Plaster, Ryan C Ellis, Alvaro C Carvalho, Jennifer Lee, Luciano Tastaldi, Lucas R Beffa, David M Krpata, Ajita S Prabhu, Clayton C Petro, Michael J Rosen, Benjamin T Miller","doi":"10.1007/s10029-026-03755-y","DOIUrl":"10.1007/s10029-026-03755-y","url":null,"abstract":"<p><strong>Purpose: </strong>Fascial tension is thought to adversely impact herniorrhaphy, but the impact of residual tension on outcomes is uncharacterized beyond the immediate postoperative period. We previously reported fascial tension changes in a case series of patients who underwent posterior component separation with transversus abdominis release (PCS-TAR) and found no association between anterior fascia closure tension and early surgical outcomes. Here we consider patient outcomes at and beyond one postoperative year.</p><p><strong>Methods: </strong>In this post-hoc analysis of a previously reported case series, surgical and patient-reported outcomes beyond one year were compared to the force (lbs) required to medialize anterior fascial elements before and after PCS-TAR. Patient demographics and surgical outcomes were captured in the Abdominal Core Health Quality Collaborative (ACHQC) registry, which was queried to identify surgical outcomes, including recurrence, wound morbidity, and patient-reported quality of life (QoL; hernia-specific and pain). Univariate regressions tested strength of association between fascial tension measures (baseline, closure, and intraoperative delta) and outcomes of interest.</p><p><strong>Results: </strong>Of the 100 patients in the original case series, long-term clinical or patient-reported follow-up was available for 77. The long-term cohort had a median hernia width of 13 cm (IQR 10, 15), median baseline fascial tension of 11 lbs (IQR 6, 19) and median closure tension of 4 lbs (IQR 2, 8). Recurrence rate was 1.4% (n = 1) among those with clinical follow-up. No tension measures were associated with recurrence, wound morbidity, or patient-reported outcomes.</p><p><strong>Conclusions: </strong>In this exploratory analysis of 77 abdominal wall reconstruction operations with PCS-TAR, a near absence of adverse outcomes were observed at one year among cases with a median residual midline closure tension of 4 lbs. Hernia-specific QoL and pain were not associated increased closure tension. The analyses are markedly limited by low event rates but tentatively suggest safety within the observed range of residual tension measurements. Larger cohorts featuring higher tension measurements are necessary to substantiate the findings and identify an upper limit of 'safe' residual tension.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251411","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":"Thirty-day outcomes of spinal versus general anesthesia for high-risk patients undergoing open inguinal hernia repair.","authors":"Renxi Li, Tyler P Tufano, Alex I Halpern, Aparna Nanduru, Arash Kiankhooy, Khashayar Vaziri, Salem I Noureldine","doi":"10.1007/s10029-026-03752-1","DOIUrl":"10.1007/s10029-026-03752-1","url":null,"abstract":"<p><strong>Background: </strong>General anesthesia (GA) is the predominant choice for open inguinal hernia repair but may be associated with a higher risk of postoperative complications, particularly in patients with multiple comorbidities. Spinal anesthesia (SA) is therefore considered as an alternative for high-risk patients. However, its potential benefits in reducing postoperative complications remain unclear. This study aimed to compare 30-day outcomes between SA and GA in high-risk patients undergoing initial open inguinal hernia repair.</p><p><strong>Methods: </strong>Patients who underwent initial open inguinal hernia repair were identified in the ACS-NSQIP database from 2005 to 2024. High-risk status was defined as a Modified Frailty Index (mFI) ≥3 and American Society of Anesthesiology (ASA) score ≥3. Exclusion criteria included emergency surgery, ventilator dependency, procedures not performed by general surgeons, cases with concomitant bowel resection, and cases where the primary anesthesia type was neither SA nor GA. A 1:1 propensity-score matching was performed to balance demographics and comorbidities between patients who received SA versus GA, and thirty-day outcomes were then compared. Additionally, a multivariable logistic regression analysis that included all high-risk patients was conducted to evaluate thirty-day outcomes while adjusting for all preoperative variables.</p><p><strong>Results: </strong>A total of 118 high-risk patients underwent open inguinal hernia repair under SA, of whom 106 were successfully propensity-score matched to 106 of the 1,365 patients who received GA. After matching, 30-day mortality rates were comparable between SA and GA (0.94% vs. 0%, p = 1.00), as were rates of organ system complications, including cardiac (0.94% vs. 1.89%, p = 1.00), pulmonary (2.83% vs. 0.94%, p = 0.62), and renal complications (1.89% vs. 0%, p = 0.50). Operative time (63.44 ± 30.61 vs. 65.05 ± 30.74 min, p = 0.70), as well as length of stay for outpatient cases (0.28 ± 0.63 vs. 0.32 ± 0.95 days, p = 0.79) were comparable between SA and GA. All other 30-day outcomes were likewise comparable. Multivariable analysis confirmed that the 30-day outcomes of SA and GA were comparable for all high-risk patients.</p><p><strong>Conclusion: </strong>In high-risk patients undergoing open inguinal hernia repair, this study showed no evidence of a difference in 30-day outcomes between SA and GA; however, given the limited statistical power, these findings should not be interpreted as evidence of equivalence. The choice between SA and GA should therefore be guided by patient-specific factors, surgical complexity, and surgeon and center expertise. Further prospective studies are needed to validate these findings.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217585","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":"Improved quality of life after combined plastic and general surgical retromuscular mesh repair for abdominal wall hernia with concurrent rectus diastasis: a retrospective cohort study of 59 post-partum woman.","authors":"H J M Smelt, I C M Driessen, E Berkvens, H Hawinkels, S W Nienhuijs, J A Wegdam, T S de Vries Reilingh","doi":"10.1007/s10029-026-03742-3","DOIUrl":"10.1007/s10029-026-03742-3","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate hernia recurrence, postoperative complications, and patient reported outcomes after combined open ventral hernia repair (OVHR) and rectus diast asis (RD) reconstruction with abdominal wall contour correction in postpartum women.</p><p><strong>Methods: </strong>This retrospective study included women (BMI < 30 kg/m2) with symptomatic ventral hernia ≥ 1 cm and concomitant RD ≥ 3 cm who underwent elective combined repair between 2018 and 2024. All patients had completed childbearing, experienced functional complaints, and maximized physiotherapy benefit. Primary outcomes were hernia recurrence and postoperative complications, classified as surgical site occurrences (SSO) and SSO requiring procedural intervention. Secondary outcomes included functional, physical, and cosmetic patient-reported outcomes.</p><p><strong>Results: </strong>Fifty-nine patients were included. Wound-related complications occurred in 38.9%, mainly wound dehiscence (18.6%) and umbilical necrosis (13.6%). Wound infection occurred in 5.1%, with 3.4% requiring radiologic drainage and 1.7% reoperation. Significant postoperative improvements were observed in abdominal pain (93.2% to 15.3%, p < 0.001), back pain (64.4% to 3.4%, p < 0.001) abdominal swelling (59.3% to 5.1%, p < 0.001), abdominal wall dysfunction (100% to 8.5%, p < 0.001), and physical limitations (61.0% to 0%, p < 0.001). Dissatisfaction with abdominal aesthetics decreased from 100% preoperatively to 18.6% postoperatively (p < 0.001). No hernia recurrence occured.</p><p><strong>Conclusion: </strong>Combined OVHR and RD reconstruction in postpartum women results in substantial improvements in pain, function, and abdominal wall aesthetics without hernia recurrence. Despite notable wound-related complications, outcomes support the functional and quality-of-life benefits of a multidisciplinary surgical approach. Prospective studies are needed to confirm these findings and optimize perioperative strategies.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217545","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":"Comparison of the effects of two drug combinations: ropivacaine-dexmedetomidine and ropivacaine-ketamine administered subcutaneously for postoperative pain control in patients with inguinal hernia: a double-blind clinical trial.","authors":"Reza Shojaei, Alireza Kamali, Zahra Eghbali, Hamed Tavan","doi":"10.1007/s10029-026-03653-3","DOIUrl":"10.1007/s10029-026-03653-3","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative pain management is a significant concern in surgery. This study aimed to compare the effects of two drug combinations, ropivacaine-dexmedetomidine and ropivacaine-ketamine, administered subcutaneously for postoperative pain control in patients undergoing inguinal hernia repair.</p><p><strong>Materials and methods: </strong>In this double-blind clinical trial, 140 patients scheduled for inguinal hernia surgery using the Lichtenstein technique at Valiasr Hospital in Arak were enrolled. They were randomly allocated into two treatment groups: dexmedetomidine + ropivacaine and ketamine + ropivacaine. The first group received dexmedetomidine 1 µg/kg plus ropivacaine 0.75% (3 mg/kg) diluted to a total volume of 10 mL with distilled water. The second group received ketamine 100 mg plus ropivacaine 0.75% (3 mg/kg) diluted to a total volume of 10 mL with distilled water. In both groups, subcutaneous injections were administered at the surgical incision site, which was then marked. Pain was assessed using the Visual Analog Scale (VAS) in the recovery room and at 2, 4, 6, 12, and 24 h postoperatively by a specialized surgical assistant. Changes in heart rate, mean arterial pressure, duration of analgesia, total opioid consumption, and complications were also recorded. Data were analyzed using SPSS version 20.</p><p><strong>Results: </strong>The mean pain score was significantly lower in the dexmedetomidine + ropivacaine group compared to the ketamine + ropivacaine group (P < 0.001). The mean duration of analgesia was significantly shorter in the ketamine + ropivacaine group (P = 0.001). The mean opioid consumption was significantly higher in the ketamine + ropivacaine group (P = 0.01).</p><p><strong>Conclusion: </strong>Dexmedetomidine, compared to ketamine, provides superior pain reduction, prolongs analgesia duration, and decreases opioid requirements following inguinal hernia repair using the Lichtenstein technique.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217579","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":"Analysis of morphological patterns in incisional hernias following different surgical approaches.","authors":"Masayoshi Hirohara, Tsuchida H, Uemura S, Ozaki Y, Saida S, Koike N","doi":"10.1007/s10029-026-03741-4","DOIUrl":"10.1007/s10029-026-03741-4","url":null,"abstract":"<p><strong>Purpose: </strong>Incisional hernia (IH) is a common complication after colorectal cancer surgery that can impair quality of life and require reoperation. However, the anatomical distribution of IH according to surgical approach and the influence of patient-related factors on hernia morphology remain poorly characterized.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent elective colorectal cancer surgery between 2009 and 2022, and included in the analysis the 464 patients who met the eligibility criteria. Patients were grouped by surgical approach: laparoscopic, upper-midline incision, or lower-midline incision. IH was diagnosed on postoperative computed tomography (CT) during at least 3 years of follow-up. Using CT data, spatial distribution, hernia midpoint (mean of the superior and inferior fascial margins) and longitudinal length were analyzed. Associations with clinical factors-including age, BMI, diabetes mellitus (DM), and pathological stage-were assessed using univariate and multivariable linear regression.</p><p><strong>Results: </strong>IH developed in 82 of 464 patients (18%). Density mapping demonstrated approach-specific spatial patterns: after upper-midline incisions, hernias clustered predominantly in the European Hernia Society M3 region, whereas hernias following lower-midline incisions were concentrated below the arcuate line in the M4 region. Hernia midpoint was not associated with patient factors, whereas hernia length was independently associated with DM and advanced tumor stage in lower-midline incisions.</p><p><strong>Conclusions: </strong>IH after colorectal cancer surgery shows approach-specific anatomical patterns reflecting regional abdominal wall vulnerability. These findings support anatomically guided risk stratification and may inform region-specific closure and prevention strategies.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217566","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 inpatient patient-reported recovery experiences after open inguinal hernia repair in Pakistan: a qualitative phenomenological study.","authors":"Amna Ikram, Abdur Rehman, Maryam Tariq, Rubab E Hira, Muhammad Ali, Asrar Ahmad Khan","doi":"10.1007/s10029-026-03746-z","DOIUrl":"10.1007/s10029-026-03746-z","url":null,"abstract":"<p><strong>Purpose: </strong>Successful inguinal hernia repair is usually measured by chronic post-operative pain severity, recurrence, and symptom resolution. These outcomes do not fully reflect patients' experiences and perceptions of recovery. This study explored patient-reported outcomes in the early post-operative period to provide insights for improving counselling, care, and patient satisfaction.</p><p><strong>Methods: </strong>This qualitative phenomenological study was conducted in the surgical units of Aziz Fatimah Hospital, Pakistan, from August to December 2025. Patients aged 18-75 years without post-operative complications were recruited via purposive sampling. Following COREQ guidelines, semi-structured interviews were conducted with informed consent, audio recorded, and transcribed. Reflexive thematic analysis was performed concurrently until thematic saturation.</p><p><strong>Results: </strong>Analysis unveiled four themes, i.e., Physical Recovery, Functional recovery and return to daily life, Psychological response, Surgery and recovery experience. Most patients reported experiencing mild to moderate post-operative pain; a few found it an acceptable part of healing, while a few reported no pain. Some patients reported tightness, backache, and sleeping difficulties. Patients desired to resume daily activities but avoid heavy lifting. Functional recovery varied. Anticipatory fears and concerns of patients were relieved by a smooth surgical experience.</p><p><strong>Conclusion: </strong>Patients' early postoperative experiences encompassed physical and functional recovery, psychological response, and surgical and recovery experience, revealing that recovery is a multidimensional process extending beyond pain resolution. This study highlights the functional, psychological, and emotional needs of patients that should be understood to improve patient care and satisfaction. Longitudinal studies can help understand patient experiences over a longer timeframe.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217594","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":"Hydrocele of the canal of nuck: a case series and literature review.","authors":"Christopher Co, Sujith Wijerathne, Leonil Dacaynos, Sajid Malik, Clement Loh, Sean Lee, Davide Lomanto","doi":"10.1007/s10029-026-03743-2","DOIUrl":"10.1007/s10029-026-03743-2","url":null,"abstract":"<p><strong>Introduction: </strong>Hydrocele of the Canal of Nuck is a rare differential for a groin lump in females. It has a heterogeneity of presentations clinically: majority are associated with a groin hernia and most cases are incidentally discovered during pre-operative imaging for groin lumps in females.</p><p><strong>Aim: </strong>The purpose of this study is to discuss the clinical, radiological, histopathological findings, and the surgical treatment of this disease, with reference to prior published literature.</p><p><strong>Method: </strong>We report our experience on cases of hydroceles of the Canal of Nuck in female adults, treated at our hernia centre with open and laparoscopic approaches from 2013 to 2026. A literature review was performed to compare our experiences with previously reported cases.</p><p><strong>Results: </strong>We reported 31 patients with hydrocele of Canal of Nuck. Twenty seven patients had pre-operative imaging with Ultrasound, Computed Tomography or Magnetic Resonance Imaging, which demonstrated the Canal of Nuck. The other four patients were incidental diagnoses made intra-operatively during inguinal hernia repair. All patients who had surgery with extra-peritoneal approach had concurrent indirect inguinal hernia which were repaired with a mesh in addition to the excision of the cyst. In two cases, multiple cysts were noted along the round ligament. All patients recovered well after surgery, with one having a seroma which resolved in 1 month. No complications or recurrence up to a minimum follow-up duration of 6 months.</p><p><strong>Conclusion: </strong>Hydrocele of Canal of Nuck is a rare condition. The differential diagnosis often includes more common causes of inguinal hernia. Most patients have associated indirect inguinal hernia or occult hernia, therefore an extra-peritoneal approach during exploration and excision of the cyst with concurrent mesh repair of the inguinal hernia is advisable to avoid future complications.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217620","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":"Environmental footprint of open versus laparoscopic inguinal hernia repair.","authors":"Agathe Herdwig, Paul Boulard, Charlotte Martin, Sam Hemati, Charlotte Maulat, Marion Castel-Molières, Fabrice Muscari","doi":"10.1007/s10029-026-03708-5","DOIUrl":"10.1007/s10029-026-03708-5","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the environmental impact of ambulatory inguinal hernia repair performed using open surgery versus laparoscopy through a life cycle assessment (LCA).</p><p><strong>Methods: </strong>A descriptive, prospective, non-interventional study was conducted at Toulouse University Hospital between October 2024 and February 2025. Intraoperative consumption of materials, energy, and medical devices was prospectively recorded in real time. Environmental impacts were quantified using a comprehensive LCA covering the full life cycle of all products used. The two surgical approaches were compared across 16 environmental impact categories of which the 8 most contributive were analyzed in detail.</p><p><strong>Results: </strong>Laparoscopic repair was associated with a 1.44-fold higher environmental impact than open surgery, with an overall score of 4.67 x 10⁻³ versus 3.23 x 10⁻³, respectively. This difference corresponded to an additional 15.5 kg CO₂-equivalent emissions per procedure. Single-use non-woven materials and cotton-based products were the main contributors, whereas operating room energy consumption and sterilization of reusable devices contributed minimally.</p><p><strong>Conclusion: </strong>In ambulatory inguinal hernia repair, the choice of surgical approach has a substantial influence on environmental impact, underscoring the importance of integrating environmental considerations into operative decision-making.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198869","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":"Electromyographic and tomographic muscle changes after botulinum toxin administration through either 3 or 8 injection points in patients with large midline ventral hernias: a superiority study.","authors":"Antonio Espinosa-de-Los-Monteros, Veronica Espinosa-Cruz, Horacio Senties-Madrid, Zurizaday Lopez-Zamora, Fernando Escamilla-Diaz, Virna Lisi Mosqueda-Larrauri, Christian Alessandro Gamboa-Lopez, Leo Bayliss-Amaya, Daniela Machicado-Quispe, Francisco Javier Frayre-Garcia, Daniel Vazquez-Zorrilla, Jorge Ramirez, Laura Mendoza-Olivas","doi":"10.1007/s10029-026-03735-2","DOIUrl":"10.1007/s10029-026-03735-2","url":null,"abstract":"<p><strong>Purpose: </strong>In this superiority study, the primary endpoint was to evaluate whether muscle changes in amplitude, thickness and length are superior when administering botulinum toxin to external and internal oblique muscles using small volumes through 8 injection points compared to large volumes through 3 injection points in patients with large midline ventral hernias. A secondary endpoint was to assess new symptoms developed after injections.</p><p><strong>Methods: </strong>Between March 2023 and July 2025, 31 patients with large midline ventral hernias underwent pre-habilitation with botulinum toxin injected to the external and internal oblique muscles. In each patient, a dose of 100 units of botulinum toxin was administered on the right side through 3 injection points using a volume of 48 cc, and the same dose was administered on the left side through 8 injection points using a volume of 16 cc. Muscle amplitude, thickness and length on each side were compared before and 4 weeks after injection using the Wilcoxon signed-ranked test for matched pairs. The changes seen between sides were compared using the Wilcoxon signed-ranked test and adjusted with the Benjamini-Hochberg false discovery rate method.</p><p><strong>Results: </strong>Muscle amplitude decreased 52% on the 8-injection point side (from 275 µV to 121 µV; p = 0.003) and 50% on the 3-injection point side (from 259 µV to 129 µV vs.; p = 0.01) (95% CI between sides [-0.14, 0.27]; p = 0.14). Muscle thickness was reduced by 31% on the 8-injection point side (from 28 mm to 18 mm; p = 0.002) and 28% on the 3-injection point side (from 28 mm to 18 mm; p = 0.004) (95% CI between sides [-0.06, 0.09]; p = 0.89). Muscle length increased 26% on the 8-injection point side (from 113 mm to 154 mm; p = 0.001) and 15% on the 3-injection point side (from 124 mm to 139 mm; p = 0.003) (95% CI between sides [-0.13, 0.04]; p = 0.61). No new symptoms were recorded after botulinum toxin injections.</p><p><strong>Conclusion: </strong>In a group of patients with large midline ventral hernias, the degree of change in muscle amplitude, thickness and length was not superior when botulinum toxin was administered using small volumes through 8 injection points compared to large volumes through 3 injection points.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198861","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}