Hernia最新文献

{"title":"5-year clinical outcome of the ESTOIH trial comparing the short-bite versus large-bite technique for elective midline abdominal closure.","authors":"René H Fortelny, Petra Baumann, Anna Hofmann, Stefan Riedl, Jan Ludolf Kewer, Jessica Hoelderle, Andreas Shamiyeh, Bettina Klugsberger, Theo David Maier, Guido Schumacher, Ferdinand Köckerling, Guido Wöste, Ursula Pession, Markus Albertsmeier","doi":"10.1007/s10029-025-03459-9","DOIUrl":"https://doi.org/10.1007/s10029-025-03459-9","url":null,"abstract":"<p><strong>Background: </strong>The short-bite technique for fascial closure after midline laparotomy has been shown to reduce the incidence of incisional hernias one year postoperatively compared to the traditional large-bite technique. However, most studies evaluating this approach have been limited to a one-year follow-up period. Initiated in 2013, the ESTOIH trial is the only randomised controlled study to include both 3-year and 5-year follow-up data. The 3-year clinical outcomes have been previously published. Herein, we report for the first time the 5-year results regarding the incisional hernia rate using the small-bite technique compared to the large-bite technique for elective midline closure.</p><p><strong>Methods: </strong>The ESTOIH study was designed as a prospective, multicentre, parallel, double-blind, randomised controlled study of primary elective midline closure. Patients were randomly assigned to receive either the small-bite or large-bite technique to close the fascia using an ultra-long-term, absorbable, elastic, monofilament suture named Monomax® based on poly-4-hydroxybutyrate. A planned 5-year follow-up was conducted, including ultrasound/radiological imaging to assess incisional hernia development as a key outcome parameter for the long-term effectiveness of the procedure.</p><p><strong>Results: </strong>In total, 362 patients were included in the 5-year ITT analysis (175 and 187 patients in the short-bite and large-bite groups, respectively). The incisional hernia rate increased in the short-bite group from 7.58% to 9.14% (p = 0.58) and in the large-bite group from 10.45% to 13.90% (p = 0.30) after 5 years compared to 3 years postoperatively. The incisional hernia rate in the short-stitch group was low, at 9.14% five years after surgery; however, the difference between the two treatment groups (short vs. long) was not significant at 5 years (OR 1.60, 95% CI [0.82-3.10]; p = 0.155).</p><p><strong>Conclusion: </strong>The previously observed increase in incisional hernias from 1 to 3 years postoperatively continued to 5 years in both stitch groups. The incisional hernia rate in the long-stitch group appeared to be higher at every time point than that in the short-stitch group. Using the short-bite technique in combination with an extra-long-term absorbable, elastic, monofilament poly-4-hydroxybutyrate suture, it may be possible to achieve a very low incisional hernia rate in the long-term follow-up.</p><p><strong>Trial registry: </strong>NCT01965249, registered October 18, 2013.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"263"},"PeriodicalIF":2.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952272","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: the impact of abdominal wall hernia (AWH) on patients' social and sexual relationships.","authors":"Alpaslan Şahin","doi":"10.1007/s10029-025-03456-y","DOIUrl":"https://doi.org/10.1007/s10029-025-03456-y","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"262"},"PeriodicalIF":2.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951883","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":"3D tomographic reconstruction in complex ventral hernias. Does it make a difference? Subjective evaluation of surgeons.","authors":"Bruno de Lima Rodrigues, Marcelo Gonçalves de Oliveira, Diego Paim Carvalho Garcia, Gustavo Soares, Bruna Flávia Cesario Senna, Henrique Araújo Lima, Fabiana Paiva Martins, Eliney Ferreira Faria","doi":"10.1007/s10029-025-03440-6","DOIUrl":"https://doi.org/10.1007/s10029-025-03440-6","url":null,"abstract":"<p><strong>Purpose: </strong>Ventral hernias are a surgical challenge, often requiring detailed imaging for surgical planning. Computed tomography (CT) is widely used in preoperative assessment, with three-dimensional (3D) reconstructions increasingly applied in surgical fields. This study aims to assess whether 3D CT reconstructions improve surgical planning compared to conventional two-dimensional (2D) CT.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted from October 2024 to January 2025, enrolling 66 surgeons with diverse experience. Participants were randomized into two groups: one assessing a complex ventral hernia using conventional CT and the other using both 2D and 3D reconstructions. Data were collected through questionnaires based on the DECOMP criteria, surgeons' perception of hernia characteristics, surgical planning, and treatment strategies. Statistical analyses, including Fisher's exact test, Chi-square test, and ROC curve analysis, were performed to compare outcomes.</p><p><strong>Results: </strong>No significant differences were found between the groups in the evaluation of the hernia, preoperative planning, or surgical approach. Surgeons predominantly relied on personal interpretation of CT scans rather than radiology reports. Notably, 3D reconstructions decreased the perception of hernia sac omental content (74.2% vs. 97.1%, p = 0.01). Furthermore, 3D visualization did not alter surgical decisions, including mesh selection, component separation, or preoperative techniques for loss of domain.</p><p><strong>Conclusion: </strong>3D CT reconstructions do not impact the evaluation or surgical planning of complex ventral hernias compared to 2D CT. Although 3D imaging may enhance anatomical visualization, its clinical utility is unclear. Conventional 2D CT, when carefully analyzed, remains sufficient for surgical decision-making. Further research is needed to assess 3D imaging's benefits.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"266"},"PeriodicalIF":2.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952243","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":"Drain versus no drain in elective open incisional hernia repair: a propensity score matching analysis using the ACHQC database.","authors":"Diego L Lima, Raquel Nogueira, Xinyan Zheng, Prashanth Sreeramoju","doi":"10.1007/s10029-025-03439-z","DOIUrl":"https://doi.org/10.1007/s10029-025-03439-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The benefits of prophylactic drain placement are controversial during elective open incisional hernia repair. The aim of this study was to evaluate drain impact on surgical site occurrences (SSO) and infection (SSI) after open elective incisional hernia repair with mesh.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who underwent elective open incisional hernia repair with permanent synthetic or resorbable synthetic mesh. A 1: 1 propensity score match (PSM) was conducted for balanced groups. Univariate analysis was performed to compare two groups (drain versus no-drain) across preoperative, intraoperative, and postoperative timeframes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The ACHQC database identified 10,821 patients with incisional ventral hernias who underwent open VHR. A PSM analysis stratified 1,337 patients to each group with a 2,674 patients. Most patients had M3 and M2 hernias (according to the EHS classification) in both groups. Median defect width was 6.0 cm (IQR 4-8) in the drain group versus 5.0 (IQR 3.0- 7.0) in the no-drain group, with no significant difference. Median hernia length was 8.0 cm (IQR 6.0-11.0) in the drain group versus 6.0 (4.0-10.0) in the no-drain group. After matching, the standard mean difference (SMD) is 0.061, indicating a good balance between groups. Recurrent hernia was higher in the drain group (607; 45% vs. 437; 33%; p &lt; 0.001). Transversus abdominis release (TAR) was higher in the drain group (198; 15% vs. 138; 10%; p &lt; 0.001). Moreover, the drain group had a higher number of cases with two meshes when compared with the no-drain group (30; 2.2% vs. 16; 1.2%; p 0.037). Sublay repair was more common in both groups, followed by Onlay repair. The retromuscular repair is the most common type of sublay repair in both groups. Moreover, median mesh width was higher in the drain group (15 cm; IQR 12-20 vs. 12 (IQR 8-15); p &lt; 0.001. The drain group had more cases with more than 180 min than to the no-drain group (419; 31% vs. 164; 12.2%; p &lt; 0.001). The Median Length of Stay (LOS) was 3 days (IQR 1-4) in the drain group and 1 day (IQR 0-3) in the no-drain group (p &lt; 0.001). (Table 4) Thirty-day readmission was higher in the drain group compared to the no-drain group (65; 4.9% versus 42; 3.1%; p = 0.002). There was no difference in reoperation and recurrence at 30 days. (Table 4) In the univariate analysis, SSI was higher in the drain group (55; 4.1% versus 35; 2.6%; p = 0.032) with no difference in SSO between the groups. When evaluating only seroma, the no-drain group had more seroma when compared with the drain group (116; 8.7% versus 73; 5.5%; p = 0.001). There was no difference in SSOPI between the groups. Regarding LOS, logistic regression demonstrated drain use (OR 2.7, CI 2.2-3.5; p &lt; 0.001), hernia length (OR 1.1, CI 1.05-1.1; p &lt; 0.001),","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"261"},"PeriodicalIF":2.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951976","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":"Subcutaneous versus retromuscular approach for the minimally invasive surgical treatment of rectus diastasis with concomitant ventral hernia: systematic review and meta-analysis of current techniques.","authors":"Lidia Castagneto-Gissey, Maria Francesca Russo, Piergaspare Palumbo, James Casella-Mariolo, Vito D'Andrea, Maria Irene Bellini, Giulio Illuminati, Giovanni Casella","doi":"10.1007/s10029-025-03430-8","DOIUrl":"https://doi.org/10.1007/s10029-025-03430-8","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review and meta-analysis aims to evaluate the outcomes of laparoendoscopic extraperitoneal techniques for repairing rectus diastasis (RD) with concomitant ventral hernias, focusing on recurrence rates, surgical site occurrences, and the effectiveness of various surgical approaches and mesh placement sites.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed and the Cochrane Library, adhering to PRISMA guidelines. Prospective and retrospective cohort studies involving adults with RD and concomitant ventral hernias were included. Surgical techniques were classified based on working space (subcutaneous vs. retromuscular) and wall repair technique (stapled vs. fascial plication suture). The primary outcome was recurrence of RD or hernia, and secondary outcomes included seroma, surgical site infections (SSIs), and bleeding.</p><p><strong>Results: </strong>Twenty-two studies comprising 1,616 patients were analyzed. Mean age was 45.6 years, BMI 30.5 kg/m², with a mean follow-up of 10.5 months. All studies were non-randomized and rated as having a \"Serious\" risk of bias using the ROBINS-I tool. Recurrence occurred in 19 patients (0.99%), with no significant differences between subcutaneous and retromuscular approaches (0.93% vs. 1.16%, p = 0.802) or between stapled and fascial plication techniques (0% vs. 1.18%, p = 0.090). Seroma rates were significantly higher in the subcutaneous group compared to retromuscular approach (11.8% vs. 0.70%, p < 0.001). SSIs were more common in subcutaneous approaches (2.33% vs. 0.58%, 0.005). Bleeding was low across all groups (1.3%), with higher rates in the stapled compared to the fascial plication group (6.39% vs. 0.37%, p < 0.001).</p><p><strong>Conclusions: </strong>Laparoendoscopic extraperitoneal approaches for RD and ventral hernia repair demonstrate favorable outcomes, with low and comparable recurrence rates among subgroups. The subcutaneous approach is associated with a higher risk of seroma formation while the stapled technique may increase bleeding risk. Further studies with higher methodological quality are needed to guide optimal technique selection.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"264"},"PeriodicalIF":2.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952111","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":"Retraction Note: Comment to: the impact of smoking on inguinal hernia repair outcomes: a meta-analysis of multivariable-adjusted studies.","authors":"Gang Wang, Zhichun Liu","doi":"10.1007/s10029-025-03445-1","DOIUrl":"https://doi.org/10.1007/s10029-025-03445-1","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"259"},"PeriodicalIF":2.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952131","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":"Cost-effectiveness of selective prophylactic mesh placement after stoma closure.","authors":"Camilo Ramírez-Giraldo, Sofía Santamaría-Forero","doi":"10.1007/s10029-025-03436-2","DOIUrl":"10.1007/s10029-025-03436-2","url":null,"abstract":"<p><strong>Background: </strong>Stoma closure is associated with a high incidence of incisional hernia, which not only impose significant costs on the healthcare system but also negatively impact patient's overall health. Prophylactic mesh placement for stoma closure has proven effective in preventing these hernias; however, its broader implementation is limited primarily by cost-effectiveness concerns.</p><p><strong>Methods: </strong>We carried out an economic evaluation to assess the cost-effectiveness of the use of selective prophylactic mesh (high-risk patients) in patients who underwent stoma closure, using data from a systematic review and meta-analysis that evaluated risk factors, and another systematic review and meta-analysis that evaluated the effectiveness of prophylactic mesh.</p><p><strong>Results: </strong>Our study showed that selective strategy offers an alternative with a lower incremental cost and comparable, although lower effectiveness. While prophylactic mesh placement in all patients has a higher incremental cost, it also has higher effectiveness. Nevertheless, the incremental cost does not exceed the threshold established in our setting of 2 times the GDP per capita.</p><p><strong>Conclusion: </strong>The use of prophylactic mesh for the closure of all stomas is a strategy that should be implemented and performed with a prosthetic mesh to be a cost-effective strategy.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"260"},"PeriodicalIF":2.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951888","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":"Association of mesh weight with adverse outcomes: a cohort study including 123,880 inguinal hernia repairs.","authors":"Brandon Cowan, Priscilla H Chan, Sahil S Patel, Heather A Prentice, Kenneth Sucher, Elizabeth W Paxton, Elliott R Brill, Lavina Malhotra, Francisca M Maertens, Gregory M Heitmann, Rouzbeh Mostaedi","doi":"10.1007/s10029-025-03427-3","DOIUrl":"https://doi.org/10.1007/s10029-025-03427-3","url":null,"abstract":"<p><strong>Purpose: </strong>Surgeons lack conclusive evidence to guide mesh choice for inguinal hernia repair. We sought to evaluate risk for recurrence, reoperation, and chronic postoperative inguinal pain (CPIP) compared among different mesh weight classes.</p><p><strong>Methods: </strong>We conducted a cohort study including 123,880 repairs in adult patients who underwent first elective mesh-based inguinal hernia repair within a US integrated healthcare system (1/2010-6/2023). Mesh weight was categorized into lightweight (LW, < 50 g), medium-weight (MW, 50-90 g), and heavyweight (HW, > 90 g). Recurrence and reoperation during follow-up were primary outcomes while 5-year CPIP was a secondary outcome. Multivariable Cox regression was used to evaluate risk of primary outcomes, while multivariable logistic regression was used to evaluate the secondary outcome; all models included covariate adjustment and stratified by surgery type.</p><p><strong>Results: </strong>LW, MW, and HW mesh were used in 49.0% (n = 23,685), 3.8% (n = 1,811), and 47.2% (n = 22,815) of minimally invasive (MIS) procedures, respectively; and were used in 55.7% (n = 42,097), 25.4% (n = 19,183), and 18.9% (n = 14,289) of open procedures, respectively. Among MIS repairs, LW mesh was associated with a lower risk of recurrence, reoperation, and CPIP versus HW, and a lower risk of recurrence and reoperation versus MW. Among open repairs, no difference was seen between LW and MW for recurrence, reoperation, and CPIP, while HW had a lower risk for recurrence and reoperation, but a higher likelihood of CPIP compared to LW.</p><p><strong>Conclusion: </strong>LW mesh was associated with a long-term advantage with fewer postoperative complications for MIS repair. HW mesh was associated with higher CPIP risk following an open repair.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"258"},"PeriodicalIF":2.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952260","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":"Short-term outcomes after robot-assisted retromuscular versus laparoscopic intraperitoneal onlay mesh repair of small-to-medium ventral hernias: a prospective, multicenter, propensity score-matched analysis.","authors":"Olivier Oberlin, Jean François Gillion, Arnaud Saget, Georgina Dinescu, Alain Valverde, Baudouin Thebault, Cyrille Kuperas, Regis Fara","doi":"10.1007/s10029-025-03431-7","DOIUrl":"https://doi.org/10.1007/s10029-025-03431-7","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the short-term outcomes of robot-assisted retromuscular (R-RM) or laparoscopic intraperitoneal onlay mesh (L-IPOM) repair of small-to-medium ventral hernias.</p><p><strong>Methods: </strong>All R-RM patients were prospectively enrolled, and their results collected in the French hernia registry. These were propensity score-matched (2:1) with L-IPOM patients whose results had already been prospectively collected in the registry. All patients had a primary or incisional hernia (M3 defect < 5 cm). The primary endpoint was the pain score on postoperative day 1 (POD1), using the 11-point numerical rating scale (NRS-11).</p><p><strong>Results: </strong>The results from 69 consecutive R-RM patients were compared to 138 matched L-IPOM patients. At POD1, the NRS-11 score was 27% lower after R-RM (3.7) than L-IPOM (5.1; p = 0.0002). Operative times were longer for R-RM (96.4 vs. 34.4 min; p < 0.0001). A higher proportion of patients underwent day surgery with R-RM (76.8%) than L-IPOM (48.8%; p < 0.0001). One Clavien IIIb postoperative complication occurred after R-RM. The overall morbidity was comparable in both groups. The time to return to work was shorter after R-RM (p = 0.0302). One month after surgery, no recurrences had been reported; the risk of NRS-11 > 0 was more than double after L-IPOM (odds ratio 2.18 [95% confidence interval 0.97; 4.91]; p = 0.0606).</p><p><strong>Conclusion: </strong>Despite a longer operative time, the R-RM approach was beneficial compared to L-IPOM in terms of postoperative pain, ambulatory rate, and time to return to work, with similar morbidity.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"257"},"PeriodicalIF":2.4,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952082","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":"Prediction of incisional hernia after kidney transplantation: analysis of wound closure technique and risk factors.","authors":"Kristoffer Huitfeldt Sola, Torkel Brismar, Tomas Lorant, Ulf Fränneby, Oskar Larsson, Helena Genberg","doi":"10.1007/s10029-025-03452-2","DOIUrl":"10.1007/s10029-025-03452-2","url":null,"abstract":"<p><strong>Purpose: </strong>Incisional hernia (IH) is a common complication after kidney transplantation, impacting morbidity and quality of life. This retrospective study aimed to identify IH risk factors and develop a predictive model.</p><p><strong>Methods: </strong>We retrospectively analysed 667 adult kidney transplant recipients (2010-2017) from two transplant centres. Medical records were screened for symptoms of abdominal wall impairment, postoperative CT scans assessed, and factors associated with IH analysed. Using the Penn Hernia Calculator, hernia probability was calculated. Adult kidney recipients transplanted 2018-2019 in Region Stockholm served as verification cohort. In a subgroup with preoperative CT scans after progression to stage 5 chronic kidney disease, muscle quality was assessed. A wound closure technique using self-locking knots, two-layer parietal running suture, and a suture-to-wound length ratio ≥ 4:1 was termed \"modified Israelsson.\"</p><p><strong>Results: </strong>Logistic regression identified age, BMI, renal replacement therapy duration, and wound closure technique as independent IH risk factors (pseudo R² = 0.15). The \"modified Israelsson method\" reduced IH odds by 83% (OR = 0.17). Sarcopenia and myosteatosis were not significant predictors. In the verification cohort, the model had 76% sensitivity for high-risk patients (≥ 10% predicted IH risk), outperforming the Penn Hernia Calculator.</p><p><strong>Conclusion: </strong>Wound closure technique is the strongest modifiable predictor of symptomatic IH identified in this cohort. The \"modified Israelsson method\" is a straightforward technique that shows strong promise for reducing incisional hernia (IH) rates and appears highly implementable. Our findings also underscore the value of developing specific predictive models for kidney transplant recipients, as generic tools may not capture crucial intraoperative factors.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"256"},"PeriodicalIF":2.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873008","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}