Hernia最新文献

{"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":"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":"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":"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":"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":"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":"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":"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}

{"title":"Does it work? comparing short-term physical performance following treatment of diastasis recti using army physical fitness test outcomes.","authors":"Elizabeth I Andersen, Thomas A Beltran, Alec K Donohue, Perry D Wiseman, Rathnayaka M K D Gunasingha, Adam J Kaplan","doi":"10.1007/s10029-026-03813-5","DOIUrl":"10.1007/s10029-026-03813-5","url":null,"abstract":"<p><strong>Purpose: </strong>Diastasis recti (DR) may impair abdominal wall function. The functional impact of operative repair remains incompletely understood. We aim to describe the effect of surgical intervention using objective physical performance outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study was performed between January 2012 to December 2023 using data from the Medical Assessment and Readiness System (MARS). Cohorts undergoing operative and non-operative treatment of DR were compared. A subset analysis was performed for patients undergoing repair who also received physical therapy. Statistical analyses were descriptive and exploratory to observe fitness patterns after different management pathways.</p><p><strong>Results: </strong>208 patients met inclusion criteria. The nonoperative group had lower baseline Army Physical Fitness Test (APFT) performance than the operative groups. Mean total APFT score changed from 214.6 to 220.9 in the repair-only group (+6.3 points at the second post-index assessment), 214.8 to 202.6 in the repair plus physical therapy group (-12.2 points), and from 201.4 to 186.6 in the nonoperative group (-14.8 points). Between-group differences at the second post-index assessment were not statistically significant for push-ups (p=0.88), sit-ups (p=0.88), run time (p=0.77), or total APFT score (p=0.98).</p><p><strong>Conclusions: </strong>In this selected cohort involving a uniquely active population consisting of military soldiers, descriptive summaries did not show clear unadjusted separation in short-term physical fitness test performance across management groups. Due to limitations of this study, these findings should be viewed as hypothesis-generating occupational observations rather than as evidence of comparative effectiveness, equivalence, or lack of benefit from operative repair.</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":"148792484","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":"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":"Comparative clinical efficacy of IPOM and TES in treating midline ventral hernias: a multicenter retrospective cohort study.","authors":"Kai Lin, Chun Yang, Fan Luo, Gaoping Zhao, Binyu Luo, Shihong Li","doi":"10.1007/s10029-026-03831-3","DOIUrl":"10.1007/s10029-026-03831-3","url":null,"abstract":"<p><p>To systematically compare the clinical outcomes of intraperitoneal onlay mesh (IPOM) repair versus total endoscopic sublay (TES) repair for midline ventral hernias, and to provide evidence for surgical decision-making. A multicenter retrospective cohort study enrolled 398 patients (IPOM = 238, TES = 160) from three tertiary hospitals (2021-2026). Baseline, perioperative, and prognostic data were compared. Baseline characteristics were similar. IPOM had greater intraoperative blood loss (20.0 vs. 10.0 mL, P < 0.001) but lower peritoneal tear (2.5% vs. 13.8%, P < 0.001) and vascular injury (1.7% vs. 6.2%, P = 0.015). Postoperatively, IPOM showed less seroma (0% vs. 6.9%, P < 0.001) but more intestinal obstruction (9.2% vs. 1.9%, P = 0.003). Total costs were higher in IPOM (¥23,800 vs. ¥16,990, P < 0.001). Chronic pain was 0% in both. TES provided better acute pain control (24‑h VAS: 1.0 vs. 4.0, P < 0.001), better 12‑month quality of life (EuraHS‑QoL: 2.0 vs. 4.0, P < 0.001), and shorter hospital stay (4.0 vs. 4.0 days, P < 0.001; median equal but significant due to distribution). Recurrence at 12 months was not significantly different (3.4% vs. 6.9%, P = 0.107). IPOM and TES offer distinct complementary advantages. IPOM had a numerically lower recurrence rate, whereas TES favored faster recovery and lower costs. Choice should be individualized.</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":"148792341","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":"The volume-outcome relationship for incisional hernia repair: analysis of an administrative dataset for England.","authors":"Michael Monaghan, Mark Cheetham, Rhys Thomas, Sam Parker, Tim W R Briggs, William K Gray","doi":"10.1007/s10029-026-03827-z","DOIUrl":"10.1007/s10029-026-03827-z","url":null,"abstract":"<p><strong>Purpose: </strong>Incisional hernia is a common complication following abdominal surgery and repair can be complex. We aimed to use an administrative dataset for England to investigate the relationship between surgeon and provider volumes and outcomes.</p><p><strong>Methods: </strong>We used data from the Hospital Episodes Statistics database for adult incisional hernia repair conducted in England from 1st April 2013 to 31st March 2025. The exposure variables were annual surgeon and provider volume defined as the number of procedures conducted in the 12 months prior to the index procedure. The primary outcome was reintervention surgery within two-years. Secondary outcomes were reintervention surgery at one and five years, length of stay greater than the median, 30-day all-cause emergency readmission and post-surgery complications. The relationship was modelled using multilevel, multivariable logistic regression with adjustment for prespecified covariates.</p><p><strong>Results: </strong>Data were available for 75,664 incisional hernia repairs conducted by 4355 surgeons within 165 providers. There was a significant relationship between greater surgeon annual volume and lower rates of reintervention surgery at two years (OR 0.995 (95% CI 0.992 to 0.998), p = 0.002) and five years (OR 0.994 (95% CI 0.991 to 0.997), p < 0.001) and between greater hospital provider volume and stay greater than the median (OR 1.001 (95% CI 1.000 to 1.002), p = 0.004). There was no relationship between volume and other short-term surgical outcomes.</p><p><strong>Conclusions: </strong>A relationship exists between lower surgeon volume and higher rates of reintervention surgery for incisional hernia repair. There was no relationship between lower surgeon or provider volume and poorer peri-surgical complications. Setting minimum surgeon annual volume thresholds may help to improve repair rates.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792495","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":"Emergency repair of incarcerated groin hernias in older adults: a retrospective cohort study of outcomes.","authors":"İnan Güden, Halil Alper Bozkurt, Melek Ezgi Kaya, Leman Damla Ercan, Mehmet İlhan, Ali Fuat Kaan Gök","doi":"10.1007/s10029-026-03802-8","DOIUrl":"10.1007/s10029-026-03802-8","url":null,"abstract":"<p><strong>Background: </strong>Emergency surgery for incarcerated groin hernias (IGH) in older adults is associated with high morbidity. While age is a known factor, the impact of physiological reserve and functional frailty on outcomes remains poorly quantified.</p><p><strong>Objective: </strong>To evaluate the impact of comorbidity burden and frailty on postoperative outcomes in older adults (≥65 years) undergoing emergency IGH repair, compared to a younger cohort (<65 years).</p><p><strong>Methods: </strong>This retrospective cohort study included 135 consecutive patients (older adults, n=62; younger patients, n=73). Baseline risk was assessed using the Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS). Primary outcome was 30-day mortality; secondary outcomes included complications and ICU admission.</p><p><strong>Results: </strong>Older adults had significantly higher physiological and functional risk profiles compared to younger patients (Mean CCI: 4.6±1.3 vs. 1.7±1.1, p<0.001; Mean CFS:4.9±1.2 vs. 2.4±0.8, p<0.001). Intestinal obstruction was more prevalent in older adults(64.5% vs. 35.6%, p=0.001). While overall complication rates were similar (19.4% vs.16.4%, p=0.677), all 30-day mortalities (n=6, 4.4% total) occurred in the older adult group (9.7% vs. 0.0%, p=0.008). Mortality was primarily driven by cardiopulmonary failure, directly correlating with higher CCI and CFS scores.</p><p><strong>Conclusions: </strong>In emergency IGH repair, 30-day mortality in older adults is driven by diminished physiological reserve and frailty rather than surgical technique. CCI and CFS are sensitive predictors of poor outcomes. High-risk patients (CFS ≥5 or CCI ≥4) require intensive perioperative optimization and closer postoperative monitoring.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722179","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":"Tissue repair: suture closure of the internal inguinal ring in rTAPP.","authors":"U A Dietz, R Frey, M Heimke, A Lalos, U Pfefferkorn, D C Chen","doi":"10.1007/s10029-026-03779-4","DOIUrl":"10.1007/s10029-026-03779-4","url":null,"abstract":"<p><strong>Background: </strong>Recurrence rates and chronic postoperative inguinal pain after groin hernia repair have remained largely unchanged over the past three decades, irrespective of surgical approach. While hernia defect closure is incorporated in some open repair techniques, closure of the internal inguinal ring during endoscopic repair has not been adopted, primarily due to concerns regarding nerve entrapment. New robotic platforms provide enhanced visualization and instrument articulation, potentially enabling safe internal ring suture closure.</p><p><strong>Methods: </strong>This prospective observational study included 43 patients with large groin hernias who underwent robotic transabdominal preperitoneal (rTAPP) inguinal hernia repair with partial suture closure of the internal inguinal ring as an adjunct to mesh implantation. Patient demographics, operative details, perioperative complications, postoperative pain, and incidence of neuropathic pain were analyzed. Quality of life was assessed using the EuraHS Quality of Life (QoL) score.</p><p><strong>Results: </strong>A total of 56 hernia sites were repaired (26 unilateral, 30 bilateral). 66% were EHS L3 hernias, 25% were inguinoscrotal, and 7.7% were recurrent. Postoperative pain decreased significantly from postoperative day 1 to day 2 (VAS score of 1.04 vs. 2.07, p = 0.0002). No patient developed neuropathic pain. The most common complication was seroma (12%). Persistent nociceptive pain beyond 30 days occurred in one patient (1.8%). All domains of the EuraHS QoL score demonstrated significant postoperative improvement.</p><p><strong>Conclusions: </strong>Partial suture closure of the internal inguinal ring during rTAPP appears feasible and safe as an adjunct to mesh implantation in selected patients. Detailed anatomical knowledge and meticulous surgical technique are essential to prevent nerve injury. Randomized controlled studies are warranted to define appropriate patient selection criteria.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706330","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}