Hernia最新文献

{"title":"The effect of surgical approach on opioid prescription rates for outpatient ventral hernia repair.","authors":"John K Ewing, Sullivan A Ayuso, Gediwon Milky, Hannah Bossie, Heather Atchison, I-Fan Shih, B Todd Heniford","doi":"10.1007/s10029-026-03834-0","DOIUrl":"10.1007/s10029-026-03834-0","url":null,"abstract":"<p><strong>Background: </strong>Reducing the use of perioperative opioids in outpatient ventral hernia repair (VHR) has potential to limit negative side effects and the risk of opioid dependence. The effect of operative approach on opioid prescription in VHR is incompletely understood. Our objective is to compare rates of opioid prescription among robotic-assisted (RVHR), laparoscopic (LVHR), and open ventral hernia repair (OVHR).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using a United States insurance claims database of outpatient VHR from 2018 to 2022. The cohort was divided into two groups: hernias coded as ventral or incisional and those coded as umbilical, epigastric, or spigelian. Opioid prescription fills were assessed at postoperative day (POD)0-14, POD15-30, and POD90-180. Surgical approaches were compared after propensity score matching (PSM) using logistic regression.</p><p><strong>Results: </strong>22,899 incisional/ventral hernia repairs (9.4% RVHR, 53.4% LVHR, and 37.2% OVHR) and 40,407 umbilical/epigastric/spigelian hernia repairs (4.3% RVHR, 21.5% LVHR and 74.1% OVHR) were included. In the incisional/ventral hernia group, RVHR and LVHR had similar opioid prescription rates POD0-14, but RVHR patients were less likely to fill opioids POD15-30 (OR = 0.65, p = 0.026). RVHR patients were also less likely to fill opioids POD15-30 (OR = 0.54, p = 0.017) relative to OVHR. In the umbilical/epigastric/spigelian group, RVHR patients were less likely to fill opioids than LVHR at POD15-30 (OR = 0.60, p = 0.033) and at POD90-180 (OR = 0.71, p = 0.021).</p><p><strong>Conclusions: </strong>RVHR was associated with fewer opioid prescriptions between POD15-30 relative to other operative approaches for ventral/incisional hernia. Along with multimodal analgesia and evidence-based prescription practices, the effect operative approach on opioid prescription should be considered.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849967","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":"Mesh fixation versus non-fixation in totally extraperitoneal inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials.","authors":"Mohamed Ali Chaouch, Hani Oweira, Wahid Fattal, Adriano Carneiro da Costa, Alessandro Mazzotta, Amine Gouader, Bassem Krimi, Rafael Novaes Jardim, Mohamed Zayati, Jean Marc Bigourdan","doi":"10.1007/s10029-026-03818-0","DOIUrl":"10.1007/s10029-026-03818-0","url":null,"abstract":"<p><strong>Background: </strong>The need for mesh fixation during totally extraperitoneal (TEP) inguinal hernia repair remains controversial. Although fixation has traditionally been used to prevent mesh displacement and recurrence, it may increase postoperative morbidity, particularly chronic postoperative inguinal pain (CPIP). This systematic review and meta-analysis aimed to compare mesh fixation versus non-fixation in adult patients undergoing laparoscopic TEP inguinal hernia repair.</p><p><strong>Methods: </strong>A systematic literature search was conducted up to February 2026. Randomized controlled trials comparing mesh fixation with non-fixation during TEP inguinal hernia repair were included. The primary outcomes were CPIP and hernia recurrence. Secondary outcomes included operative time, early postoperative pain, seroma, urinary retention, length of hospital stay, and costs. Risk of bias was assessed.</p><p><strong>Results: </strong>Sixteen randomized controlled trials including 1,608 patients were included. Mesh fixation was associated with a significantly higher risk of CPIP compared with non-fixation (RR 1.68; 95% CI 1.29 to 2.19; p = 0.0001). No statistically significant difference in hernia recurrence was detected between fixation and non-fixation groups (RR 0.53; 95% CI 0.22 to 1.23; p = 0.14); however, recurrence events were rare, and this analysis may be underpowered to exclude small but clinically relevant differences. Fixation was associated with a longer operative time (MD 3.16 min; 95% CI 1.04 to 5.27; p = 0.003), slightly higher 24-hour postoperative pain (MD 0.21; 95% CI 0.03 to 0.38; p = 0.02), increased urinary retention (RR 3.61; 95% CI 1.88 to 6.93; p = 0.0001), and a marginally longer hospital stay (MD 0.10 days; 95% CI 0.02 to 0.18; p = 0.01). Seroma formation did not differ significantly between groups (RR 1.05; 95% CI 0.70 to 1.58; p = 0.81). Costs were generally higher in the fixation group, mainly because of fixation devices. Publication bias assessment for outcomes with at least 10 studies did not suggest major small-study effects. The certainty of evidence was high for CPIP, moderate for recurrence and most secondary outcomes, and low for urinary retention.</p><p><strong>Conclusions: </strong>Mesh fixation was associated with a higher risk of CPIP without a statistically significant reduction in hernia recurrence. However, recurrence events were uncommon, and the available evidence does not establish equivalence or non-inferiority between the two strategies, particularly for patients with large medial or direct defects. Fixation was also associated with modest increases in operative time, early postoperative pain, urinary retention, hospital stay, and costs. Overall, non-fixation appears to be a reasonable strategy in appropriately selected patients, while selective fixation may remain relevant for large direct defects or other high-risk situations.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818295","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":"Open versus robotic transversus abdominis release for ventral hernia repair: an updated systematic review and meta-analysis.","authors":"Jorge Henrique Cavalcanti Orestes Cardoso, Clara Avelar Mendes de Vasconcelos, Guilherme de Carvalho Caldas, Thiago Souza E Silva, Raquel Nogueira, Leandro Totti Cavazzola, Diego Laurentino Lima, Flavio Malcher","doi":"10.1007/s10029-026-03833-1","DOIUrl":"10.1007/s10029-026-03833-1","url":null,"abstract":"<p><strong>Background: </strong>While robotic transversus abdominis release (rTAR) offers distinct advantages over the open technique (oTAR) for complex ventral hernia repairs (VHR), its adoption rate lags behind. Despite superior peri- and postoperative outcomes, oTAR remains more widely utilized. The aim of this study is to conduct an updated systematic review and meta-analysis comparing rTAR and oTAR approaches for ventral hernia repair (VHR) patients.</p><p><strong>Methods: </strong>PubMed, Cochrane, Embase and Web of Sciences were systematically searched from inception to February 2026 to identify randomized controlled trials and observational studies comparing rTAR versus oTAR for VHR. Meta-analyses were performed using a DerSimonian-Laird random-effects model, and statistical heterogeneity was assessed using Cochran's Q test and the I² statistic. All analyses were conducted in R (version 4.4.0).</p><p><strong>Results: </strong>A total of 1,363 references were initially yielded, of whom only 10 observational studies, comprising 1,085 patients, 461 oTAR and 624 rTAR, were included in the analysis. The mean age was 62.3 years in the robotic group and 59.7 years in the open group. The mean BMI was 31.7 kg/m² in the robotic group and 31.4 kg/m² in the open group. Females comprised approximately 56% of the robotic cohort and 57% of the open cohort. The analysis showed that rTAR was associated with a statistically significant reduction in the SSO (OR 0.48; 95%CI 0.28 to 0.80; p-value = 0.004; I² = 15.4%), SSI (OR 0.27; 95%CI 0.13 to 0.55; p-value = 0.0003 I² = 0%) and readmission (OR 0.39; 95%CI 0.20 to 0.75; p-value = 0.004; I² = 0%) rates, being also associated with a statistically significant decrease in the mean LOS time (MD -4.65 days; 95%CI -5.65 to -3.66; p-value < 0.001; I² = 64.8%). However the implementation of rTAR was associated with a significant increase in operation time (MD 42.64 min; 95%CI 9.30 to 75.98; p-value = 0.012; I²= 83.4%) and no statistically significant difference was found regarding the recurrence rates (OR 0.89; 95%CI 0.30 to 2.63; p-value = 0.829; I² = 0%).</p><p><strong>Conclusion: </strong>Current observational data suggests that rTAR may offer a decreased odds of SSO, SSI, readmission rate and LOS when compared with oTAR. However, rTAR was associated with increased operative time.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818302","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":"Perioperative safety and long-term outcomes of mesh repair in nonagenarians undergoing elective inguinal hernia repair: a single-center retrospective study.","authors":"Hekai Shi, Shaochun Li, Binbin He, Xiaoyu Peng, Dongchao Yang, Zhicheng Song, Yan Gu","doi":"10.1007/s10029-026-03830-4","DOIUrl":"https://doi.org/10.1007/s10029-026-03830-4","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate perioperative safety, long-term outcomes, and factors associated with Clavien-Dindo grade ≥ II complications in nonagenarians undergoing elective inguinal hernia repair.</p><p><strong>Methods: </strong>The main cohort of this retrospective study included nonagenarians who underwent elective inguinal hernia repair between 2013 and2025. Preoperative, intraoperative, and postoperative data were collected. The primary outcome was Clavien-Dindo grade ≥ II complications. Univariable logistic regression was used to identify associated factors. Nonagenarians who underwent emergency groin hernia repair during the same period were analyzed separately as a supplementary descriptive cohort.</p><p><strong>Results: </strong>The elective cohort comprised 152 patients (median age 91.0 years), all of whom underwent mesh repair (Lichtenstein in 129, 84.9%). Median hospital stay was 7.0 days, and median follow‑up was 30.0 months. Postoperative complications occurred in 22 patients (14.5%), including 12 (7.9%) with Clavien‑Dindo grade ≥ II. The 30‑day mortality was 1.3%. During the follow‑up, recurrence was detected in 2 patients (1.3%) and chronic pain in 6 (3.9%). In univariate logistic regression, preoperative functional dependence was significantly associated with grade ≥ II complications (odds ratio 16.27, 95% CI 2.82 to 93.86, P = 0.002). In the emergency repair cohort (n = 29), 10 patients (34.5%) developed grade ≥ II complications, all of which were surgery‑related deaths.</p><p><strong>Conclusions: </strong>In clinically selected nonagenarians undergoing elective inguinal hernia repair, mesh repair showed acceptable perioperative safety and favorable long-term local outcomes. Preoperative functional status, rather than chronological age alone, should be emphasized in surgical decision-making.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818273","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":"Defining complex groin hernia and contextualizing approach selection: a three-round Delphi consensus framework.","authors":"Davide Cavaliere, Sara Capoccia Giovannini, Filippo Paratore, Angelo Iossa, Francesco Gossetti, Pier Luigi Ipponi, Gabriele Munegato, Giampiero Campanelli, Giuseppe Cavallaro, Cesare Stabilini","doi":"10.1007/s10029-026-03825-1","DOIUrl":"https://doi.org/10.1007/s10029-026-03825-1","url":null,"abstract":"<p><strong>Background: </strong>The term \"complex groin hernia\" is widely used in clinical practice but lacks a standardized operational definition and a structured framework to guide escalation, referral pathways, and approach selection.</p><p><strong>Methods: </strong>A three-round Delphi process was conducted with a fixed panel of 54 Italian expert abdominal wall surgeons evaluating 85 statements across elective and emergency scenarios spanning (1) definition of complexity, (2) hernia characteristics, (3) patient characteristics, and (4) previous surgical history. Items were scored on a 5-point Likert scale in Rounds 1-2 and on a 3-point scale in Round 3. Consensus was graded as no consensus (< 65%), leaning agreement/disagreement (65-80%), or agreement/disagreement (> 80%).</p><p><strong>Results: </strong>Overall, 44 of 85 statements (51.8%) achieved at least leaning consensus (≥ 65%): 34 in agreement and 10 in disagreement; strong consensus (> 80%) was reached for 18 statements (21.2%). In elective surgery, complexity was mainly defined by escalation needs, including requirement for a highly experienced surgeon and/or referral to a dedicated center. Emergency presentation should be regarded as a time-sensitive complexity setting; within this domain, consensus clustered around bowel compromise/obstruction and contaminated or dirty fields as severity and planning markers, not as transfer criteria. For approach selection, the panel converged toward a change-of-plane principle for recurrence. Obesity-related items showed heterogeneous views and did not translate into a single preferred approach. Operative time emerged as a pathway-planning modifier rather than a fixed determinant of operative plane.</p><p><strong>Conclusions: </strong>This Delphi study proposes a conservative, non-prescriptive framework to define and report complex groin hernia. Its most robust outputs concern expertise escalation, emergency risk markers, and the change-of-plane principle for recurrence, while areas of weaker agreement should be interpreted as expertise-sensitive decision nodes requiring external validation.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792492","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":"Parastomal hernia in the difficult patient: is Tophat plasty the solution?","authors":"Johnsen Tb, Stornes T, Bernstein Te","doi":"10.1007/s10029-026-03776-7","DOIUrl":"https://doi.org/10.1007/s10029-026-03776-7","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of the study was to evaluate the safety, feasibility and short- and long - term outcomes following the Tophat plasty - a complete extra-abdominal procedure - for parastomal hernia.</p><p><strong>Methods: </strong>A prospective observational single-center study including all patients operated with Tophat plasty at a regional tertiary referral university hospital in the period 2020-2024.</p><p><strong>Results: </strong>Twenty- three patients were treated with the Tophat plasty. All procedures were performed by two surgeons. The median age was 70 years. Fifteen of the patients were males. Twelve patients had an ileal conduit, 7 had a colostomy and 4 had an ileostomy. The most common indication for surgery was obstruction, and three patients were operated in an acute setting. Medium operating time was 213 minutes. Two patients had recurrence after previous surgery for parastomal hernia. Three had concomitant incisional hernias. Ten patients had complications of which were registered according to the Clavien-Dindo classification. The median hospital stay was 6 days, and median follow-up was 34 months. Three (13%) recurrences were identified, of which two (9%) needed intervention.  CONCLUSION: The Tophat plasty is an effective method for the treatment of parastomal hernias in cases where lateralization of the stoma is not feasible, intra-abdominal mesh placement has to be avoided, or when access to the abdominal cavity is challenging.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792521","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":"Clinical predictors of bowel resection in incarcerated femoral hernias: A single-center cohort study.","authors":"Sezer Bulut, Turgut Dönmez, Yasir Musa Kesgin, Nurettin Şahin, Deniz Güzey, Alpen Yahya Gümüşoğlu, Özden Canöz, Göker Çalış, Abdülhak Hamit Karayağız, Murat Çikot, Ahmet Sürek","doi":"10.1007/s10029-026-03829-x","DOIUrl":"https://doi.org/10.1007/s10029-026-03829-x","url":null,"abstract":"<p><strong>Purpose: </strong>Incarcerated femoral hernias carry a notoriously high risk of bowel strangulation due to the rigid anatomy of the femoral ring. This study aimed to determine the clinical, demographic, and baseline laboratory predictors of irreversible bowel ischemia requiring resection in a strictly homogeneous cohort of patients undergoing emergency surgery for incarcerated femoral hernias.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 100 consecutive patients who underwent emergency surgical repair for incarcerated femoral hernias between January 2019 and December 2023 at a single tertiary referral center. Patients were stratified into two cohorts based on the intraoperative requirement for bowel resection: the Resection Group (n = 23) and the Non-Resection Group (n = 77). Preoperative clinical data, demographic features, body mass index (BMI), symptom duration, and admission white blood cell (WBC) counts were analyzed using univariate analysis and multivariate binary logistic regression to isolate independent risk factors.</p><p><strong>Results: </strong>Intestinal resection was required in 23% of cases. In the multivariable logistic regression model, an elevated admission white blood cell (WBC) count (OR = 1.24, 95% CI: 1.09-1.41, p < 0.001) and prolonged symptom duration (OR = 1.72, 95% CI: 1.05-2.82, p = 0.031) were identified as independent predictors of bowel resection. ROC analysis identified a WBC cut-off of 12.3 × 10³/µL (AUC: 0.784) and a symptom duration threshold of 1.5 days (AUC: 0.675). In a post-hoc subgroup analysis, patients presenting with both a WBC count and symptom duration above these thresholds had a bowel resection rate of 81.8% (9/11); however, this descriptive finding should be interpreted with caution because of the small subgroup size.</p><p><strong>Conclusion: </strong>Admission leukocytosis and prolonged symptom duration were identified as independent predictors of bowel resection in patients with incarcerated femoral hernias. These readily available clinical parameters may assist in preoperative risk stratification; however, the post-hoc subgroup findings should be interpreted with caution and require prospective multicenter validation.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792387","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":"Robotic TAPP repair of lateral abdominal wall hernias: a multi-center experience.","authors":"Michael R Freund, Ephraim Katz, Lauren Lahav, Alon Schwartz, Lior Segev, Yaron Rudnicki, Shmuel Avital, David Hazzan","doi":"10.1007/s10029-026-03835-z","DOIUrl":"https://doi.org/10.1007/s10029-026-03835-z","url":null,"abstract":"<p><strong>Introduction: </strong>Lateral hernias are uncommon and technically challenging defects, with limited data guiding optimal surgical management. Robotic repair has emerged as a promising approach, though evidence remains sparse and largely limited to small single center series. This study aimed to evaluate the feasibility and short to mid-term outcomes of robotic trans abdominal preperitoneal (TAPP) lateral hernia repair in a multi-center cohort.</p><p><strong>Methods: </strong>A retrospective multi-center study was conducted including consecutive adult patients undergoing robotic TAPP repair of lateral abdominal wall hernias. Hernias were classified according to the European Hernia Society classification. Demographics, operative details, and postoperative outcomes were analysed using descriptive statistics.</p><p><strong>Results: </strong>A total of 39 patients were included. The majority of hernias were incisional, with a predominance of left-sided defects. Median hernia size was within the moderate range, with most classified as L2-L3 and W2 according to EHS criteria. All procedures were completed robotically, predominantly using a preperitoneal approach. Median operative time was 150 min, with minimal blood loss in all cases and with no conversions. Overall morbidity was 23.1%, with most complications being minor. Major complications occurred in 7.7% of patients and included two bowel obstructions requiring reoperation. Median length of stay was 1 day, with low readmission and reoperation rates. At a median follow-up of 60.5 weeks, no recurrences were observed. Postoperative pain was low, with minimal opioid requirements.</p><p><strong>Conclusions: </strong>Robotic TAPP repair of lateral hernias appears to be a feasible approach for complex lateral abdominal wall defects, with acceptable early postoperative outcomes in this multi-center retrospective series. This multi-center series adds to the limited literature and supports the role of robotics in this challenging subset of hernias. Further studies with longer follow up are needed to assess long term durability.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792487","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":"A randomized controlled trial of a plastic-sheath technique to facilitate self-gripping mesh placement in laparoscopic inguinal hernia repair.","authors":"Jakrapan Jirasiritham, Chairat Supsamutchai, Napaphat Poprom, Thanida Janbavonkij, Pongsasit Singhatat, Tharin Thampongsa, Jarinya Wilasrusmee, Theejutha Meakleartmongkol, Settanan Plangsiri, Panupol Thepyasuwan, Chumpon Wilasrusmee","doi":"10.1007/s10029-026-03823-3","DOIUrl":"https://doi.org/10.1007/s10029-026-03823-3","url":null,"abstract":"<p><strong>Background: </strong>Self-gripping mesh reduces recurrence and postoperative pain but is difficult to deploy due to its adhesive properties.</p><p><strong>Methods: </strong>We developed a plastic-sheath covering technique to facilitate mesh placement. In Phase I, prototypes were evaluated for placement time and surgeon satisfaction. In Phase II, a randomized controlled trial (NCT04394338) compared the optimized sheath with conventional placement in laparoscopic inguinal hernia repair.</p><p><strong>Results: </strong>Prototype 4 achieved the shortest placement time in Phase I. In Phase II (n = 26), the plastic-sheath method significantly reduced mesh placement time (4.56 ± 1.80 vs. 7.40 ± 1.52 min; P = 0.005) and improved surgeon satisfaction (8.00 vs. 6.31; P = 0.003). Postoperative pain, hospital stay, and complication rates were comparable between groups.</p><p><strong>Conclusions: </strong>The plastic-sheath method simplifies self-gripping mesh deployment, reduces operative time, and improves surgeon satisfaction without increasing complications.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792356","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":"Does defect size matter? Risk of venous thromboembolism and pulmonary embolism after ventral hernia repair.","authors":"Oswaldo Subillaga, Aixa Pérez Coulter, Jacqueline Wu","doi":"10.1007/s10029-026-03819-z","DOIUrl":"https://doi.org/10.1007/s10029-026-03819-z","url":null,"abstract":"<p><strong>Purpose: </strong>New CPT codes for Ventral hernia repair (VHR) by fascial defect size were introduced in 2023. Venous thromboembolism (VTE) and pulmonary emboli (PE) represent potentially preventable postoperative complications with significant morbidity. We studied the association between hernia fascial defect size and postoperative outcomes.</p><p><strong>Methods: </strong>We identified patients in the 2023 National Surgical Quality Improvement Program (NSQIP) dataset and stratified by hernia defect size, type, and severity. Descriptive statistics were calculated. Relative risk was modeled by logistic regression.</p><p><strong>Results: </strong>A total of 12,947 VHRs were recorded: 46% <3 cm, 42% 3-10 cm, and 12% >10 cm. There were 29 (0.2%) instances of VTE: 6 (0.1%), 10 (0.2%), and 13 (0.8%) for <3 cm, 3-10 cm, and > 10 cm respectively (p < 0.001). Similarly, there were 27 (0.2%) instances of PE: 5 (0.1%), 10 (0.2%), and 12 (0.8%), respectively (p < 0.001). Due to the differences in patients between the groups, relative risks were modeled by logistic regression. Relative risk (95% CI) of VTE compared to <3 cm was 1.05 (0.38, 2.92) for the 3-10 cm group and 2.45 (0.88, 6.77) for > 10 cm. The relative risk (95% CI) of PE compared to <3 cm was 1.62 (0.55, 4.83) for the 3-10 cm group and 3.59 (1.18, 10.91) for > 10 cm. Further analysis showed a higher incidence of PE (20 [0.2%] vs. 7 [0.5%], (p = 0.01) for recurrent hernias compared to initial presentation. STRATIFYING BY OPERATIVE APPROACH DEMONSTRATED SIGNIFICANTLY INCREASED RISK OF BOTH VTE AND PE IN FASCIAL DEFECT SIZE > 10 CM WHEN REPAIRED LAPAROSCOPICALLY: 6.63 (1.32, 33.4) AND 9.69 (1.79, 52.4) RESPECTIVELY.</p><p><strong>Conclusion: </strong>While the unadjusted relative risk of both VTE and PE was higher with bigger fascial defects, adjusting for both patient demographics and medical history revealed an association between increasing risk of PE and fascial defect > 10 cm. Further, the laparoscopic approach is associated with greater risk of both DVT and PE when the fascial defect size is > 10 cm. Chemical thromboprophylaxis should be considered for patients undergoing VHR if their fascial defect is > 10 cm.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792528","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}