Hernia最新文献

{"title":"Comment to: long-term wound morbidity and hernia recurrence in diabetic patients with hba1c ≥ 8.5% undergoing open transversus abdominis release.","authors":"Ihtisham Ul Haq, Wadiha Shah, Hamna Ijaz","doi":"10.1007/s10029-026-03853-x","DOIUrl":"10.1007/s10029-026-03853-x","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060603","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":"ReTAPP for recurrent inguinal hernia after laparoscopic repair: extended experience and comparative analysis.","authors":"Francisco Javier Thibaud, Enzo Morel, Joaquín Fernandez Alberti, Raúl Eduardo Croceri, Diego Bogetti, Pablo Medina, Daniel Pirchi","doi":"10.1007/s10029-026-03855-9","DOIUrl":"10.1007/s10029-026-03855-9","url":null,"abstract":"<p><strong>Purpose: </strong>Current international guidelines recommend an open anterior approach for inguinal hernia recurrence after a previous laparo-endoscopic repair. However, repeated laparoscopic repair (reTAPP) has emerged as a potential alternative in highly specialized centers. We aimed to compare the safety, feasibility, and outcomes of reTAPP versus open anterior repair in patients with recurrence after previous laparoscopic inguinal hernia repair.</p><p><strong>Methods: </strong>Retrospective analysis of all transabdominal preperitoneal (TAPP) repairs performed between January 2010 and December 2023. Patients with recurrence were divided into Group 1 (reTAPP) and Group 2 (open anterior repair, Lichtenstein). Demographics, operative variables, postoperative outcomes, morbidity, and re-recurrence were assessed.</p><p><strong>Results: </strong>Among 3,728 TAPP repairs, 76 recurrences (2.03%) were identified. Fifty-one patients (67.1%) underwent reTAPP and twenty-five (32.9%) open repair. Operative time was 87.5 min in Group 1 vs. 91.2 min in Group 2 (p = 0.59). Hospital stay was shorter with reTAPP (0.6 vs. 1.2 days; p < 0.05). Postoperative pain scores were significantly lower in Group 1 at discharge and at 1 week (p < 0.05). Overall morbidity was low (9.8% vs. 12%), with minor wound complications in both groups, all managed conservatively. Conversion rate in Group 1 was 7.8% due to adhesions. Re-recurrence rates were comparable (3.9% vs. 4.0%).</p><p><strong>Conclusion: </strong>In high-volume centers, reTAPP is a safe and effective option for recurrent inguinal hernia after prior laparoscopic repair, associated with shorter hospital stay and less postoperative pain, with comparable re-recurrence rates.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060585","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":"Patient narratives in an online hernia peer-support community: a qualitative netnographic analysis.","authors":"Asim A Abbas, Natyra Xharavina, Jackie Bullock, Srinivas Chintapatla","doi":"10.1007/s10029-026-03860-y","DOIUrl":"10.1007/s10029-026-03860-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to explore how individuals with hernia engage with online peer-support communities and how their shared narratives reflect the experience of living with and seeking treatment for hernia.</p><p><strong>Methods: </strong>A qualitative netnographic approach was employed, analysing posts from a large online hernia support group with approximately 8,500 members across more than 10 countries. The group was selected following scoping of alternative online communities because of its size, activity, heterogeneity, and public accessibility. A purposive sample of 26 high-engagement discussion threads comprising 936 comments was analysed using Braun and Clarke's reflexive thematic analysis, involving iterative familiarisation, inductive coding, theme development, and refinement. Saturation was monitored throughout, and data collection concluded when no new dominant themes were identified.</p><p><strong>Results: </strong>Four inductively derived themes were identified: Surgical Experiences and Outcomes, Patient Concerns and Fears, Healthcare System and Access, and Coping and Support. Narratives described mesh-related anxiety, fear of recurrence, mistrust in healthcare providers, structural barriers to care, body-image concerns, and uncertainty surrounding treatment and recovery. Mesh discussions included concerns about safety, long-term complications, and living with an implanted material, alongside positive experiences of mesh repair. Participants also demonstrated active health-information-seeking behaviours, including peer validation, appraisal of surgical options, and self-advocacy. A visual summary of findings is included (see accompanying infographic).</p><p><strong>Conclusion: </strong>Online patient narratives offer rich insight into the lived experience of hernia and demonstrate how peer communities contribute to information seeking, support, and treatment-related discussion. These exploratory findings identify issues relevant to patient-centred communication and future outcomes research and suggest value in recognising the digital patient as an active information-seeker and co-producer of meaning.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060595","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":"From pixels to prediction: CT morphometrics and artificial intelligence in complex ventral hernia repair.","authors":"Umang Kumar Agrawal, Sakshi Jaiswal, Anand Kumar Singh","doi":"10.1007/s10029-026-03844-y","DOIUrl":"10.1007/s10029-026-03844-y","url":null,"abstract":"<p><strong>Purpose: </strong>Complex ventral hernia repair requires more than conventional assessment of defect width and location. Computed tomography (CT) provides quantitative information on hernia morphology, loss of domain, abdominal wall musculature, adipose distribution, and body composition that can improve preoperative risk stratification and surgical planning. Concurrently, artificial intelligence (AI) offers opportunities to automate image analysis, standardize morphometric assessment, and develop predictive models for individualized decision-making. This review critically evaluates the current evidence regarding CT-derived morphometrics and AI applications in the assessment and management of complex ventral and incisional hernias.</p><p><strong>Methods: </strong>A structured literature review was conducted using PubMed/MEDLINE, Scopus, and Web of Science from database inception to the final search date before manuscript submission. Studies evaluating CT-derived morphometric parameters, loss-of-domain assessment, body-composition analysis, radiomics, machine learning, and AI applications in ventral and incisional hernia surgery were included. Eligible studies underwent methodological quality assessment using validated tools appropriate to study design, and findings were synthesized narratively because of substantial heterogeneity in imaging protocols, morphometric definitions, AI methodologies, and reported outcomes.</p><p><strong>Results: </strong>CT-derived morphometrics provide objective characterization of hernia anatomy beyond conventional defect dimensions. Volumetric assessment, standardized loss-of-domain measurements, abdominal wall muscle morphology, sarcopenia, myosteatosis, and adipose distribution have demonstrated associations with fascial closure, requirement for component separation, surgical-site occurrences, and postoperative outcomes. Emerging AI applications-including automated image segmentation, radiomics, and machine-learning prediction models-have shown promising performance for quantitative image analysis and individualized risk prediction. However, the current evidence remains limited by predominantly retrospective single-centre studies, heterogeneous methodologies, inconsistent imaging definitions, small datasets, and limited external validation, precluding widespread clinical implementation.</p><p><strong>Conclusion: </strong>Quantitative CT morphometrics combined with AI has the potential to transform complex ventral hernia assessment from descriptive imaging to evidence-based, patient-specific surgical planning. Future progress will depend on standardized CT acquisition and reporting, consensus morphometric definitions, multicentre collaborative datasets, rigorous external validation of predictive models, and prospective evaluation of their clinical utility before routine implementation in abdominal wall reconstruction.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024768","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":"Comparative outcomes of bioabsorbable poly-4-hydroxybutyrate versus synthetic mesh in ventral hernia repair: A propensity-matched cohort study.","authors":"Kartik S Akkihal, Kelly M Dickerson, Anya Ittiruck, Gerald O Ogola, Christine Wang, Mazen Iskander, Steven G Leeds, Marc A Ward, Bola Aladegbami","doi":"10.1007/s10029-026-03848-8","DOIUrl":"10.1007/s10029-026-03848-8","url":null,"abstract":"<p><strong>Purpose: </strong>Poly-4-hydroxybutyrate (P4HB) biosynthetic mesh offers a bioabsorbable alternative to permanent synthetic mesh in ventral hernia repair, but comparative outcome data are limited by selection bias, as P4HB is preferentially used in complex and contaminated cases.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adults undergoing ventral hernia repair with P4HB, biologic, or permanent synthetic mesh at a single tertiary center from January 2014 to January 2025. The primary outcome was hernia recurrence. Secondary outcomes included 30-day postoperative complications, mesh infection, and time to recurrence. Of 506 patients, 32 with non-ventral hernias and 71 with missing mesh type data were excluded, leaving 403 ventral hernia repairs for analysis (45 P4HB, 22 biologic, and 336 permanent synthetic). Patients receiving P4HB were matched 1:1 to patients receiving permanent synthetic mesh using propensity scores derived from age, sex, body mass index, diabetes, CDC wound class, Ventral Hernia Working Group grade, and hernia size.</p><p><strong>Results: </strong>In the unmatched cohort, P4HB patients had larger hernia defects, higher VHWG grades, more contaminated CDC wound classes, and longer operative times than patients receiving permanent synthetic mesh. Mesh infection and hernia recurrence were low and did not differ significantly between groups, but P4HB patients had higher rates of 30-day reoperation, ileus, and small bowel obstruction. After propensity score matching (25 P4HB vs 25 permanent synthetic), operative time was similar between groups. Hernia recurrence remained uncommon and was not significantly different (4.0% vs 8.0%, p=0.55), and mesh infection rates were also low (0% vs 8.0%, p=0.15). P4HB was associated with lower 30-day surgical site infection (0% vs 16.7%, p=0.04) and surgical site occurrence (4.2% vs 33.3%, p=0.01), while other 30-day outcomes were not significantly different.</p><p><strong>Conclusions: </strong>In this retrospective, single-center propensity-matched cohort, long-acting resorbable poly-4-hydroxybutyrate mesh demonstrates comparable recurrence and mesh infection rates with lower short-term wound morbidity after balancing key risk factors, suggesting bioabsorbable mesh to be a reasonable alternative to synthetic mesh in selected complex or contaminated ventral hernia repairs. However, the modest matched sample size, exclusions due to missing data, and follow-up shorter than the expected P4HB resorption period warrant cautious interpretation and emphasize the need for larger studies with longer-term follow-up.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982639","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":"Operative vs non-operative management of ventral hernia: a population based study of long-term benefits and consequences.","authors":"Sourav Kumar Podder, Julia A Baran, Scott H Koeneman, Francesco Palazzo, Nicole L Dugan, Christopher Keating, Sami Tannouri","doi":"10.1007/s10029-026-03845-x","DOIUrl":"10.1007/s10029-026-03845-x","url":null,"abstract":"<p><strong>Purpose: </strong>Ventral hernia (VH) management has progressed beyond simply physical repair of the defect. It now involves a strategy that purposefully restores abdominal core function and prevents future complications. This study investigates the association between ventral hernia repair (VHR) and functional disorders related to the abdominal core in addition to bowel obstruction, opioid misuse, and physical therapy utilization.</p><p><strong>Methods: </strong>This retrospective cohort study used administrative codes from the TriNetX database. The outcomes of interest were spine and pelvic floor dysfunction, constipation, incontinence, genital prolapse, bowel obstruction, opioid misuse, and physical therapy utilization.</p><p><strong>Results: </strong>A total of 587 384 patients were identified with diagnosis of VH. Of those, 81 830 (13.9%) underwent surgical repair. Surgery was associated with a significant reduction in the hazard for bowel obstruction (HR 0.65, 95% CI [0.63, 0.67]). There were no association between surgery and the hazard of opioid misuse (0.97, [0.93, 1.01]). The hazard ratios associated with surgery were 1.05 (1.02, 1.07) for spine and pelvic dysfunction, 1.03 (0.99, 1.05) for constipation, 0.97 (0.93, 1.01) for incontinence, and 0.88 (0.72, 1.07) for genital prolapse. The hazard ratio for physical therapy utilization after surgery was 1.76 (1.73, 1.80).</p><p><strong>Conclusions: </strong>VHR is associated with reduction in the hazard of bowel obstruction, while having no significant effect on opioid misuse. Additionally, surgical patients had a higher utilization of physical therapy. While surgical management was not associated with a reduction in the hazard of functional disorders, further research is warranted to better understand these relationships.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982634","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":"Botulinum toxin, progressive pneumoperitoneum and RTL closure for ventral hernias secondary to giant omphalocele in children: a 10-patient series.","authors":"Mario Javier Peña Garcia, Edgard Efren Lozada-Hernández, Alejandro Alberto Peñarrieta Daher, Jaime Penchyna Grub, Guillermo Jacobo Serrano Meneses, Ricardo Reynoso González, Ivan Vladimir Medina Lopez","doi":"10.1007/s10029-026-03851-z","DOIUrl":"10.1007/s10029-026-03851-z","url":null,"abstract":"<p><strong>Introduction: </strong>This study describes a pediatric strategy to repair complex ventral hernias secondary to giant omphaloceles, avoiding the use of mesh and component separation. The protocol combines prehabilitation with botulinum toxin (BT), selective preoperative progressive pneumoperitoneum (PPP) and midline closure by the reinforced tension line (RTL) technique, with the aim of evaluating its safety, feasibility and medium-term results.</p><p><strong>Methods: </strong>A retrospective, descriptive and multicenter case series was conducted in 10 patients under 18 years of age with ventral hernia secondary to giant omphalocele. All patients received BT; PPP was indicated in patients whose Tanaka index was ≥25%. Surgical closure was performed using the RTL technique, without prosthetic material. Clinical characteristics, dimensions of the defect, use of prehabilitation, complications, hospital stay, follow-up and recurrence were analyzed.</p><p><strong>Results: </strong>Ten patients were included, all of whom were female, with a median age of 3.7 years and a median weight of 12.7 kg. The median defect area was 60 cm². Four patients required progressive pneumoperitoneum. Primary fascial closure was achieved in 100% of cases, without mesh or separation of components. There were no intraoperative complications. The median hospital stay was 6.5 days, and the median follow-up was 19.8 months. No recurrences were documented.</p><p><strong>Conclusions: </strong>The combined protocol seems safe and technically viable in this initial series. It allowed primary fascial closure without mesh, without separation of components and without recurrences during follow-up. However, these results should be interpreted as preliminary evidence because of the retrospective design, small sample size and absence of a control group.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982662","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":"Adductor tendinopathy as a source of ongoing chronic postoperative inguinal pain-evaluating outcomes of adductor tenotomy.","authors":"T W K van der Meer, M J A Loos, J van Grinsven, M R M Scheltinga, W A R Zwaans","doi":"10.1007/s10029-026-03850-0","DOIUrl":"10.1007/s10029-026-03850-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the outcome of an adductor muscle tenotomy in patients with chronic postoperative inguinal pain (CPIP) with a therapy-resistant adductor tendinopathy.</p><p><strong>Methods: </strong>In this retrospective cohort study, CPIP patients who underwent an adductor tenotomy between January 2019 and December 2024 at MMC were identified using a CTcue search and an operative code. They were categorised according to the extent of surgical procedure (isolated group: adductor tenotomy only; combined group: mesh removal and/or tailored neurectomy combined with adductor tenotomy). Outcome was successful (excellent or good) or not (moderate or poor).</p><p><strong>Results: </strong>A total of 32 tenotomies were identified in 29 CPIP patients (25 males, mean age 59 years). All had previously undergone conservative therapies without achieving significant pain relief. The success rate in the isolated group was 57.1% (8 of 14 procedures). Success in the combined group was attained by 61.1% (11 of 18 procedures). No major complications were reported.</p><p><strong>Conclusions: </strong>Adductor tendinopathy can contribute to symptoms in some patients with CPIP. An adductor muscle tenotomy may be effective in approximately 60% of CPIP patients with a therapy-resistant adductor tendinopathy, either as an isolated procedure or as an adjunct during mesh removal and/or tailored neurectomy. These preliminary findings call for the need of further studies with standardised diagnostic criteria and validated outcome measures.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982631","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":"Comment to: who will repair the next open inguinal hernia? educational consequences of declining open surgery volumes.","authors":"Francesco Gossetti, Pierluigi Ipponi, Gabriele Munegato, Linda D'Amore, Paolo Negro","doi":"10.1007/s10029-026-03856-8","DOIUrl":"10.1007/s10029-026-03856-8","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982672","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":"Learning curve in robotic inguinal hernia repair: a systematic review and meta-analysis.","authors":"Gabriela Lyons, Ana Luiza Aguiar Peres Kozlowski Breves, Vitor Neves, Paula Cambuli-Bianchi, Raquel Nogueira, Leandro Totti Cavazzola, Diego L Lima, Flavio Malcher","doi":"10.1007/s10029-026-03843-z","DOIUrl":"10.1007/s10029-026-03843-z","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to perform a systematic review and meta-analysis to assess the learning curve in robotic transabdominal preperitoneal (rTAPP) inguinal hernia repair in adult patients, emphasizing the number of procedures associated with improved operative efficiency and the evolution of operative performance over time.</p><p><strong>Materials and methods: </strong>A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, Lilacs and SciELO was performed through March 2026, including cohort studies on adult patients undergoing elective robotic inguinal hernia repairs. Studies were eligible for quantitative synthesis if operative time was reported across distinct learning phases. Operative time between phases was pooled using a random-effects model, and mean differences (MD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I² statistic.</p><p><strong>Results: </strong>622 articles were screened, of which 13 met the inclusion criteria and were included in the systematic review. All studies evaluated learning curves in multiport rTAPP inguinal hernia repair. A total of 1,770 patients were included, of whom 1,465 were male (82.8%), with a mean BMI was 25.3 kg/m² (SD 3.3). Four studies defined two phases (learning and post-learning) and reported operative time per phase, allowing inclusion in the quantitative synthesis. A random-effects meta-analysis demonstrated a significant reduction in operative time between Phase 1 and Phase 2 (MD 17.02 min, 95% CI 5.91-28.14; I² = 86%). CUSUM-based studies for operative time in rTAPP reported a median proficiency threshold of 32 cases (IQR 18.5).</p><p><strong>Conclusions: </strong>Among studies using operative-time-based CUSUM analyses, a median threshold of 32 cases was associated with improved operative efficiency in rTAPP, as reflected by reduced operative time. Progression beyond this initial learning phase is consistently associated with improved operative efficiency, including a pooled reduction of 17.02 min in operative time. Future studies should incorporate competency-based assessments and clinically meaningful outcomes to provide a more comprehensive evaluation of surgical proficiency.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982698","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}