Hernia最新文献

{"title":"Management and outcome of mesh infection after abdominal wall reconstruction in a tertiary care center.","authors":"Victor Franchi, Claire Triffault-Fillit, Sophie Jarraud, Jean-Yves Mabrut, Clément Javaux, Olivier Monneuse, Anne Conrad, Tristan Ferry, Maud Robert, Florence Ader, Guillaume Passot, Florent Valour","doi":"10.1007/s10029-025-03265-3","DOIUrl":"10.1007/s10029-025-03265-3","url":null,"abstract":"<p><strong>Purpose: </strong>Abdominal wall reconstruction is a common surgical procedure, with a post-operative risk of mesh-associated infection of which management is poorly known. This study aims to comprehensively analyze clinical and microbiological aspects of mesh infection, treatment modalities, and associated outcomes.</p><p><strong>Methods: </strong>Patients with abdominal mesh infection were included in a retrospective observational cohort (2010-2023). Patients characteristics and management were described, and determinants for failure were assessed by logistic regression and treatment failure-free survival curve analysis (Kaplan-Meier).</p><p><strong>Results: </strong>Two hundred and nine patients (median age, 62 [IQR, 55-71] years) presented a mesh infection occurring within 15 (IQR, 7-31) days after surgery, mainly as an abdominal wall or deep abscess (n=189, 90.4%). Infection was polymicrobial in 89/166 (79.4%) cases, S. aureus (n=60, 36.1%), Enterobacteriaceae (n=60, 36.1%) and anaerobes (n=40, 24.1%) being the most prevalent pathogens. Surgery was performed in 130 (62.2%) patients, associated with a 13.5 (IQR, 8-21) day course of antimicrobial therapy in 172/207 (83.1%) cases. Sixty-three (30.1%) treatment failures occurred, associated with previous multiple abdominal surgeries (OR, 3.305; 95%CI, 1.297-8.425), complete mesh removal (OR, 0.145; 95%CI, 0.063-0.335) and antimicrobial therapy (OR, 0.328; 95%CI, 0.136-0.787). The higher failure rate of conservative strategies was associated with symptom duration >1 month (OR, 3.378; 95%CI, 1.089-4.005) and retromuscular mesh position (OR, 0.444; 95%CI, 0.199-0.992).</p><p><strong>Conclusion: </strong>Mesh infection is associated with high treatment failure rates. Complete mesh removal coupled with targeted antibiotic therapy is associated with better outcomes. Conservative treatment strategies must rely on careful patient selection based on symptom duration and mesh placement.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"76"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023253","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":"Outcomes after surgical repair of primary parastomal hernia.","authors":"Nulvin Djebbara-Bozo, Nellie B Zinther, Anette Søgaard, Hans Friis-Andersen","doi":"10.1007/s10029-025-03267-1","DOIUrl":"10.1007/s10029-025-03267-1","url":null,"abstract":"<p><strong>Purpose: </strong>Parastomal hernia is a frequent complication after stoma construction, with increasing incidence over time. Surgical repair is reported with a high recurrence rate and the evidence on the topic is limited. We conducted a retrospective study to evaluate the incidence of recurrence after parastomal hernia repair and assessed the risk factors and predictors for recurrence at the Regional Hernia Center at Horsens Regional Hospital, Denmark.</p><p><strong>Methods: </strong>119 patients underwent primary parastomal hernia repair from January 2017 until April 2021. Mean follow-up period was 72 months. Information including demographic data, non-modifiable risk factors and modifiable risk factors were assessed and analyzed using LASSO to select relevant predictors and GLM was employed hereafter.</p><p><strong>Results: </strong>Multivariate analysis showed that age, diabetes, IBD, constipation, and fecal incontinence were strong pre-operative predictors, with age, IBD, ileostomy, and colorectal cancer also reaching significance in univariate analyses. Post-operatively, EHS classification 1, and Clavien Dindo Grade 3b were identified as strong predictors in univariate analyses.</p><p><strong>Conclusion: </strong>Recurrence after parastomal hernia repair was 17.64% during a follow-up period of minimum 3.5 years.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"72"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023255","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: Use of prophylactic mesh to prevent parastomal hernia formation.","authors":"Tayfun Bisgin, Aras Emre Canda","doi":"10.1007/s10029-025-03268-0","DOIUrl":"https://doi.org/10.1007/s10029-025-03268-0","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"71"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023292","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 extended total extraperitoneal transversus abdominus release for traumatic flank and abdominal intercostal hernias.","authors":"Antonela Muca, Kimberly Aung, Mikholae Hutchinson, Ashley Beale, Randy Janczyk, Anthony Iacco","doi":"10.1007/s10029-024-03192-9","DOIUrl":"https://doi.org/10.1007/s10029-024-03192-9","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic abdominal intercostal/flank hernias present a perplexing challenge for surgeons seeking to repair them. There has been a paucity of studies describing robotic repairs of such hernias. We aim to evaluate the effectiveness of the Robotic-assisted Extended Total Extraperitoneal/Transversus Abdominus Release (rETEP/TAR) method in repairing traumatic abdominal intercostal and flank hernias.</p><p><strong>Methods: </strong>Patients with traumatic abdominal intercostal hernias at a high-volume hernia center between 2019 and 2022 were identified and retrospective data including patient demographics, perioperative parameters, postoperative complications and up to a three-year follow-up were collected for those undergoing rETEP/TAR. Robotic ETEP access was gained through the retro-rectus space ipsilateral to the hernia, using a transversus abdominis release performed laterally to the level of the posterior axillary line. Dissection was completed from the pelvis to the central tendon as necessary.</p><p><strong>Results: </strong>A total of 8 patients were analyzed. All patients suffered traumatic or Valsalvainduced hernias. The average age was 54 +/-15yrs. The mean defect size was 11x17cm. Heavyweight uncoated polypropylene mesh was placed in the retromuscular space and secured with transfascial suture. Mean mesh size was 34x30cm and mean operative time was 216 +/- 69 minutes. The median length of stay was 1 day. All patients reported improvement in pain without any evidence of recurrence at postoperative follow-up.</p><p><strong>Conclusion: </strong>This study demonstrates that the Robotic-assisted ETEP/TAR technique is an effective way of repairing abdominal intercostal and flank hernias.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"80"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023294","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":"Comment to: Post operative pain associated with ProGrip mesh hernioplasty.","authors":"Ibrahim Khansa, Jeffrey E Janis","doi":"10.1007/s10029-025-03269-z","DOIUrl":"https://doi.org/10.1007/s10029-025-03269-z","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"74"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023291","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":"Cessation vs. no cessation of acetylsalicylic acid preoperatively in laparoscopic totally extraperitoneal inguinal hernia repair (CAPTAIN): interim report from a multicentre, single-blind, randomised controlled trial.","authors":"Marcus Yeow, Lydia Tan, Sean Lee Kien Fatt, Mehak Mahipal, Rajeev Parameswaran, Lynette Loo, Sujith Wijerathne, Davide Lomanto","doi":"10.1007/s10029-025-03263-5","DOIUrl":"https://doi.org/10.1007/s10029-025-03263-5","url":null,"abstract":"<p><strong>Background: </strong>Given the increasing prevalence of antiplatelet agent use and the lack of high-quality evidence, the CAPTAIN trial aimed to investigate the safety and provide recommendations on continuing acetylsalicylic acid perioperatively in patients undergoing elective laparoscopic totally extraperitoneal inguinal hernia repair (LIHR).</p><p><strong>Methods: </strong>The CAPTAIN trial was a multicentre, surgeon blind, randomized controlled trial conducted from April 2016 to April 2023. Patients undergoing LIHR were eligible for inclusion. Participants were randomized to either the acetylsalicylic acid cessation group or the continued acetylsalicylic acid group. The primary endpoint was the incidence of hematoma formation at discharge.</p><p><strong>Results: </strong>After a total of 69 patients were randomized, four patients dropped out, leaving 35 patients in the acetylsalicylic acid cessation group and 30 in the continued acetylsalicylic acid group. The baseline characteristics of both groups were similar. While the distribution of hernia types was largely comparable, there were significantly more direct inguinal hernias in the continued acetylsalicylic acid group (p < 0.001). The primary outcome, hematoma formation at discharge, was similar between groups (3.3% vs. 2.9%, p = 1.000). Secondary outcomes, including wound bruising, post-discharge hematomas, pain, seroma formation, wound infection rates, and length of hospital stay, did not differ significantly between groups. No thromboembolic complications, readmissions, chronic pain, or recurrences were observed during follow-up in either group.</p><p><strong>Conclusion: </strong>This study found that it is safe to continue acetylsalicylic acid perioperatively in selected patients undergoing LIHR without an increased risk of complications.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"78"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023289","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 literature-based cost-effectiveness analysis of device-assisted suturing versus needle-driven suturing during laparotomy closure.","authors":"Zin Min Thet Lwin, Gabriel Börner, Sophia Verheij-Engqvist, George Keel","doi":"10.1007/s10029-025-03266-2","DOIUrl":"10.1007/s10029-025-03266-2","url":null,"abstract":"<p><strong>Purpose: </strong>Small-bites suturing technique for laparotomy closure is now recommended as the standard of care. However, uptake of the practice remains slow. A medical technology called the SutureTOOL has been developed which can facilitate implementation of small-bites. The aim of the study was to compare the economic and clinical outcomes of laparotomy closure for patients using manual needle-driver suturing versus device-assisted suturing (SutureTOOL) following open abdominal surgery.</p><p><strong>Methods: </strong>This cost-effectiveness analysis comparing device-assisted suturing to needle-driver suturing was performed from a healthcare perspective within Sweden, France, the UK, and the US. A decision tree model was developed to implement the analysis.</p><p><strong>Results: </strong>The SutureTOOL was found to be cost-effective, reducing costs between 22% and 40% across country contexts. Savings were associated with reduced post-operative complications and reductions in operating room time. Improvements in quality of life were minimal and not clinically significant, likely because of the short time horizon.</p><p><strong>Conclusion: </strong>Cost-effectiveness was largely due to cost savings. Prior to procurement, hospitals should test the device to ensure that small-bite rates and reductions in operation time are replicable within their clinical context. If so, the device will improve quality of care for laparotomy wound closure.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"77"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023287","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":"Impact of preoperative frailty status on decision regret following elective hernia repair.","authors":"Leah J Schoel, Joshua Sinamo, Brian T Fry, Alexander Hallway, Michael Rubyan, Ryan Howard, Jenny M Shao, Sean M O'Neill, Dana A Telem, Annie P Ehlers","doi":"10.1007/s10029-024-03254-y","DOIUrl":"https://doi.org/10.1007/s10029-024-03254-y","url":null,"abstract":"<p><strong>Purpose: </strong>Decision regret following hernia repair is common, particularly for patients who experience complications. Frailty is a risk factor for complications, but whether frailty is independently associated with regret remains unknown.</p><p><strong>Methods: </strong>We retrospectively reviewed the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry, a representative sample of adult patients from > 70 hospitals across Michigan. We included patients who underwent elective ventral and incisional hernia repair (VIHR) or groin hernia repair (GHR) from 2020 to 2021 and completed a survey measuring regret. Frailty was quantified using validated 5-factor modified frailty index (mFI5): no (mFI5 = 0), moderate (mFI5 = 1), or severe frailty (mFI5 ≥ 2). Primary outcome was regret at 90-days. Multivariable regression models evaluated the association of frailty with regret.</p><p><strong>Results: </strong>795 patients underwent VIHR: 294 (37.0%) were moderately frail, and 127 (16.0%) were severely frail. Severely frail patients were older, more often male, more comorbid, had higher BMI, and had larger hernias (all p < 0.05). Regret was demonstrated in 88 patients (11.1%). 2502 patients underwent GHR: 966 (38.6%) moderately frail, and 213 (8.5%) severely frail. Severely frail patients were older, had higher BMI, and more comorbidities (all p < 0.001). 271 persons (10.8%) expressed regret. For both VIHR and GHR, frailty was not associated with regret (p > 0.05). There were no differences in complications by frailty status (p = 0.10 and p = 0.22).</p><p><strong>Conclusion: </strong>Despite their higher risk, persons with frailty are not more likely to express regret following hernia repair. Decision regret is important for evaluating quality-of-life operations, but frailty status should not be used alone to predict risk of decision regret.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"75"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023251","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":"Structured hernia surgery training program for general practitioners in Rwanda - feasibility and evaluation.","authors":"Ralph Lorenz, Lea Hubert, Christoph Paasch, Joachim Conze, Chris Oppong, Jacob A Akoh, David M Sedgwick, Venuste Nsabimana, René Mantke","doi":"10.1007/s10029-025-03260-8","DOIUrl":"10.1007/s10029-025-03260-8","url":null,"abstract":"<p><strong>Background: </strong>Hernias are among the most common surgical conditions worldwide, with significant prevalence in Africa. However, according to recent WHO statistics, Africa faces a critical shortage of trained surgeons. Structured surgical training programs are also scarce. Since 2016, Surgeons for Africa in collaboration with Operation Hernia have developed structured training course on hernia surgery specifically for surgeons in Rwanda. Due to the severe shortage of surgeons, a new initiative was launched in 2023 to train general practitioners (GPs) to support the country's surgical care needs. This study aims to assess the feasibility and effectiveness of these training programs for general practitioners.</p><p><strong>Methodology: </strong>Six standardized questionnaires were used to evaluate the structured training program before, during, and after the one-and-a-half-week courses conducted in Rwanda. Both trainees and trainers completed the relevant evaluations. The results were anonymized, ummarized using descriptive statistics, and statistically analysed. Trainers also assessed the surgical competence of each participant at the end of the course.</p><p><strong>Results: </strong>Between 2023 and 2024, 47 general practitioners received hernia surgery training in several Rwandan hospitals. The course significantly improved both the theoretical knowledge and practical surgical skills of the participants. Of the 47 GPs, 22 were able to independently perform simple inguinal hernia surgeries after the training. Three were able to perform complex inguinal hernia repairs independently. 12 participants required minimal supervision, while 22 required full supervision.</p><p><strong>Conclusion: </strong>This study confirms the feasibility and effectiveness of a standardized hernia surgery training program for general practitioners in Rwanda. The results demonstrate the rogramme's potential to address the surgical care gap by enabling GPs to perform basic hernia surgeries.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"73"},"PeriodicalIF":2.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022446","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 approach for abdominal wall reconstruction after ventral hernia: open versus minimally invasive surgery.","authors":"Andrea González De Godos, Javier Sánchez González, Beatriz López Rodríguez, Andrea Carlota Lizarralde Capelastegui, Guillermo Estébanez Peláez, David Pacheco Sánchez, Miguel Toledano Trincado","doi":"10.1007/s10029-025-03264-4","DOIUrl":"https://doi.org/10.1007/s10029-025-03264-4","url":null,"abstract":"<p><strong>Introduction: </strong>The classic open ventral hernia repair provides excellent results in recurrences. However, wound complications are the Achilles heel for a good overall clinical outcome. Laparoscopic surgery is in general associated with less pain, better esthetic results, faster recovery, and lower incidence of wound complications. Robotic procedures provide increased degrees of freedom, may improve ergonomics, and allow scaling and performance of finer movements deemed difficult through alternate surgical approaches.</p><p><strong>Purpose: </strong>The aim of this study is to compare outcomes between open and minimally invasive approaches, with the primary objective of determining differences in postoperative course and hospitalization.</p><p><strong>Methods: </strong>Patients underwent any of the three procedures: open Rives-Stoppa, laparoscopic eTEP or robotic eTEP between June 2020 and January 2024 for the treatment of one or more midline abdominal wall hernias alongside rectus abdominis diástasis. The width diameter of the hernias was between 3 and 10 cm and techniques that did not place the mesh in a retromuscular position or required component separation are excluded.</p><p><strong>Results: </strong>Robotic surgery had a lower score on the visual analogue scale for pain at discharge (p-value < 0.00). Minimally invasive surgery allows for the placement of larger meshes compared to the open approach (p < 0.05), although the surgical time is longer (p-value < 0.00). There were no statistically significant differences for hospital stay (p-value = 0.46), complications (p-value = 0.52) or recurrence (p-value = 0.70).</p><p><strong>Conclusion: </strong>Minimally invasive surgery allows for the placement of larger meshes compared to the open approach without increasing the morbidity of the procedure or the immediate postoperative pain, despite generally having longer operative times.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"29 1","pages":"69"},"PeriodicalIF":2.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004642","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}