Hernia最新文献

{"title":"Peritoneal flap hernioplasty for complex ventral hernias: a prospective evaluation of patient-reported quality of life and short-term outcomes.","authors":"Sagar Chavan, Chirag Kakadiya, Vikas Singhal, Azhar Perwaiz, Amanjeet Singh, Adarsh Chaudhary","doi":"10.1007/s10029-026-03821-5","DOIUrl":"10.1007/s10029-026-03821-5","url":null,"abstract":"<p><strong>Purpose: </strong>Prospective data evaluating patient-reported outcomes after Peritoneal Flap Hernioplasty (PFH) are scarce. We aimed to prospectively evaluate quality of life (QoL) using the EuraHS-QoL instrument in complex ventral hernia patients undergoing PFH and determine if the postoperative abdominal bulge associated with this bridge technique impacts clinical success from the patient's perspective.</p><p><strong>Methods: </strong>A prospective observational cohort study was conducted at a single tertiary care centre from June 2023 to June 2025. Consecutive patients undergoing PFH with or without component separation for large ventral hernias were enrolled. Quality of life (QoL) was assessed using a Hindi translation of the validated EuraHS-QoL score preoperatively and at 3 months postoperatively.</p><p><strong>Results: </strong>Of the 61 enrolled patients, one was excluded due to an iatrogenic bowel injury, resulting in population of 60. Safety outcomes were evaluated for all 61 patients, whereas efficacy outcomes were assessed for the remaining 60. The mean EuraHS-QoL score demonstrated significant improvement, declining from 43.67 ± 4.70 preoperatively to 14.40 ± 3.73 at the 3-month follow-up. The mean defect width was 9.38 ± 4.75 cm, with an average operative duration of 249.92 ± 99.69 min. Minor morbidity occurred in 19.7% of cases, and one major complication (1.6%, n = 61) required mesh explantation due to iatrogenic bowel injury. No hernia recurrences were identified at the 3-month follow-up; although 21.7% of patients reported subjective abdominal bulging, none exhibited clinical or radiological recurrence.</p><p><strong>Conclusion: </strong>PFH offer statistically significant improvement in patient-reported quality of life and low rates of early complications. PFH instils reasonable confidence among surgeons, as the anticipated bulge from this bridge technique does not necessarily indicate decreased QoL or recurrence. It serves as an effective, selective strategy for complex hernia repairs, though further long-term observation is required to determine its durable functional success.</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":"148706319","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":"Technical refinements of pediatric laparoscopic percutaneous extraperitoneal closure for adult indirect inguinal hernia.","authors":"Shoko Kato, Takuya Saito, Kenitiro Kaneko, Remi Kondo, Nozomi Matsushita, Yasuyuki Fukami, Tsuyoshi Sano","doi":"10.1007/s10029-026-03816-2","DOIUrl":"10.1007/s10029-026-03816-2","url":null,"abstract":"<p><strong>Purpose: </strong>Laparoscopic percutaneous extraperitoneal closure (LPEC) is an established procedure for pediatric inguinal hernia repair. In adults, however, its application is technically more demanding because of a thicker abdominal wall, greater tissue resistance, and a deeper ligation plane. Based on our standardized pediatric LPEC technique, we describe technical refinements for adult indirect inguinal hernias and examine an important cautionary finding related to patient selection.</p><p><strong>Methods: </strong>Among adults with suspected indirect inguinal hernia treated between 2023 and 2025, 20 patients who underwent LPEC were evaluated. For adult cases, we incorporated several technical refinements, including double ligation, puncture-site enlargement, tension reduction during ligation, and needle-route straightening.</p><p><strong>Results: </strong>The procedure was completed in selected adults, including those with a high body mass index and greater abdominal wall thickness. Recurrence occurred in two patients, both of whom had preoperative bowel protrusion. This finding suggests that bowel protrusion should be regarded as an important cautionary feature when considering the indication for adult LPEC.</p><p><strong>Conclusion: </strong>Standardized pediatric LPEC may be adapted for selected adults when appropriate technical refinements are applied. However, cases with preoperative bowel protrusion require particularly careful judgment when determining indication.</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":"148706335","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: Comparison of open and laparoscopic inguinal hernia repair in the elderly patients: a randomized controlled trial.","authors":"Rahul Kumar, Aaditya Odhwani, Anmol, Kuldeep Deewan","doi":"10.1007/s10029-026-03820-6","DOIUrl":"10.1007/s10029-026-03820-6","url":null,"abstract":"","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":"148706327","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":"Evaluation of usefulness of manual reduction in the management of adult acute irreducible abdominal wall hernia: a study from a community-based teaching hospital. Author's Reply.","authors":"Yozo Suzuki","doi":"10.1007/s10029-026-03795-4","DOIUrl":"https://doi.org/10.1007/s10029-026-03795-4","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684371","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":"Effect of neuromuscular blockade reversal strategy on gastrointestinal recovery following abdominal wall reconstruction: a randomized controlled trial.","authors":"Daphne Remulla, Noah X Tocci, Ryan C Ellis, William C Bennett, Alvaro Carvhalo, Chao Tu, Alparslan Turan, Luciano Tastaldi, Ajita S Prabhu, David M Krpata, Lucas R Beffa, Benjamin T Miller, Michael J Rosen, Clayton C Petro","doi":"10.1007/s10029-026-03814-4","DOIUrl":"10.1007/s10029-026-03814-4","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate the impact of sugammadex on gastrointestinal recovery following complex AWR.</p><p><strong>Methods: </strong>This single-center, double-blinded, randomized controlled trial randomized 184 patients undergoing open retromuscular AWR to receive either sugammadex or neostigmine/glycopyrrolate for neuromuscular blockade reversal per drug packaging protocol. The primary outcome was time to gastrointestinal recovery (GI-2), defined as tolerance of solid food and first bowel movement and univariate and multivariate analysis was used to compare sugammadex and neostigmine/glycopyrrolate cohorts. Secondary outcomes included incidence of POI, hospital length of stay, and opioid consumption among our two cohorts.</p><p><strong>Results: </strong>The final analysis included 177 patients (88 sugammadex, 89 neostigmine/glycopyrrolate). Median time to GI-2 recovery was similar between groups (89 vs. 87 h, Wilcoxon rank-sum p = 0.637). No significant differences were observed in POI incidence (21% vs. 25%, p = 0.52) or length of stay (5 vs. 4 days, p = 0.90). Multivariable analysis confirmed sugammadex did not significantly affect time to GI-2 recovery (HR 0.96, 95% CI 0.69-1.32, p = 0.79). Independent predictors of delayed recovery included POI development and greater opioid consumption.</p><p><strong>Conclusions: </strong>Sugammadex did not result in faster return to gastrointestinal function when compared with neostigmine/glycopyrrolate when used for neuromuscular blockade reversal. Thus, avoidance of neostigmine/glycopyrrolate did not reduce POI incidence or hospital length of stay in patients undergoing complex AWR.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684403","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":"Preoperative botulinum toxin a enables fascial closure and reduces morbidity in complex incisional hernias: results from the BRIDGE-HERNIA study.","authors":"Francesco Pizza, Francesco Saverio Lucido, Alejandro Bravo Salva, Umberto Bracale, Santina Precisano, Montserrat Juvany Gomez, Pietro Maida, Dario D'Antonio, Camillo Bertoglio, Simona Gili, Camilla Massa, Alessandra Conzo, Gianpaolo Marte, Chiara Dell'Isola, Ludovico Docimo, Claudio Gambardella","doi":"10.1007/s10029-026-03811-7","DOIUrl":"10.1007/s10029-026-03811-7","url":null,"abstract":"<p><strong>Background: </strong>Achieving tension-free midline fascial closure in complex midline incisional hernias frequently necessitates posterior component separation with transversus abdominis release (TAR). Preoperative administration of botulinum toxin A (BTA) has been proposed as an adjunctive strategy to induce temporary chemical relaxation of the lateral abdominal wall, potentially facilitating primary fascial closure and reducing the need for TAR. This study evaluates the impact of BTA within the BRIDGE-HERNIA protocol on surgical management of patients with complex incisional hernia.</p><p><strong>Methods: </strong>This retrospective multicenter observational cohort study conducted across three centers included 42 patients with complex midline incisional hernias and transverse defect width ≥ 10 cm. All patients underwent ultrasound-guided preoperative injections of BTA into the lateral abdominal wall muscles. Computed tomography (CT) scans obtained before and after BTA administration were used to assess changes in transverse defect width and lateral muscle elongation. Surgical repair was tailored intraoperatively based on fascial tension, with Rives-Stoppa repair performed when feasible and TAR reserved for cases with persistent tension.</p><p><strong>Results: </strong>After BTA administration, 33 of 42 patients (78.6%) underwent successful Rives-Stoppa repair without the need for TAR. Mean lateral muscle elongation was 3.5 ± 1.2 cm per side, associated with a significant reduction in transverse defect width from 12.4 ± 3.1 cm to 10.1 ± 2.6 cm (p < 0.001). Fascial closure was achieved in all patients treated with Rives-Stoppa repair. The overall complication rate was 23.8%, with a significantly lower incidence of postoperative complications in the Rives-Stoppa group compared with the TAR group (15.2% vs. 55.6%, p < 0.05). Median length of hospital stay was shorter in patients managed without TAR (4.6 vs. 6.2 days, p = 0.034). One early recurrence was observed, occurring in the TAR group. EuraHS-QoL scores demonstrated significant improvement at both 6 and 12 months postoperatively, indicating a sustained enhancement in hernia-specific quality of life.</p><p><strong>Conclusions: </strong>Preoperative BTA administration within the BRIDGE-HERNIA protocol effectively facilitated midline fascial closure and substantially reduces the need for TAR in patients with complex midline incisional hernias. This approach appeared safe, was associated with reduced postoperative morbidity and shorter hospitalization, and led to meaningful improvements in patient-reported quality of life. CT-based morphometric assessment confirmed objective muscular elongation and supports its selective use as a decision-support tool in high-complexity cases, where preoperative stratification of TAR probability has meaningful clinical implications.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684416","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":"Speed in surgery: does it still matter?","authors":"Giampiero Campanelli","doi":"10.1007/s10029-026-03826-0","DOIUrl":"https://doi.org/10.1007/s10029-026-03826-0","url":null,"abstract":"","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684421","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":"Diagnostic value of shear wave elastography in assessing the effectiveness of preoperative botulinum toxin type A therapy in patients with postoperative ventral hernias W3.","authors":"R S Rajabzoda, A V Protasov, O I Mazurova","doi":"10.1007/s10029-026-03812-6","DOIUrl":"10.1007/s10029-026-03812-6","url":null,"abstract":"<p><strong>Introduction: </strong>Complex W3 ventral hernias with loss of domain (LOD) pose challenges in abdominal wall reconstruction due to pathological retraction and increased stiffness of the lateral abdominal muscles. Preoperative botulinum toxin type A (BTA) facilitates tension-free closure, but objective assessment remains poorly standardized. Two-dimensional shear wave elastography (2D-SWE) enables non-invasive quantification of tissue stiffness.</p><p><strong>Methods: </strong>This prospective study included 20 healthy volunteers (control) and 6 patients with EHS W3 ventral hernias. Reference stiffness values for external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were established using 2D-SWE. Patients underwent stiffness measurements before BTA, one month after BTA, and at 1,3,6,12 months postoperatively. All underwent Rives-Stoppa hernioplasty.</p><p><strong>Results: </strong>Control reference values were 13.38 kPa (EO), 13.61 kPa (IO), and 15.23 kPa (TrA). Before BTA, hernia patients showed elevated EO (24.2 ± 4.8) and IO (20.6 ± 2.3) stiffness (p < 0.001), while TrA stiffness (17.8 ± 3.6) did not differ from controls (p = 0.09). One month after BTA, stiffness decreased (EO: 14.3 ± 2.4, p = 0.21 vs. controls; IO: 10.2 ± 1.8, p < 0.001; TrA: 9.6 ± 1.2, p < 0.001). Postoperative stiffness progressively declined through 12 months (EO: 7.8 ± 0.9; IO: 7.4 ± 0.8; TrA: 7.3 ± 0.4). Primary fascial closure was achieved in all patients without additional component separation.</p><p><strong>Conclusions: </strong>2D-SWE provides objective assessment of BTA-induced muscular relaxation and postoperative remodeling. Established control reference values enable reliable stratification of pathological stiffness and monitoring of therapeutic response, supporting personalized surgical planning.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684429","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":"Closed-incision negative-pressure wound therapy in abdominal wall reconstruction: a systematic review and meta-analysis.","authors":"Jorge Henrique Cavalcanti Orestes Cardoso, Bernardo Gabriele Collaco, Jessica Zilberman Macret, Denise Padilha Abs de Almeida, Mariana de Macedo Torves, Raquel Nogueira, Flavio Malcher, Diego Laurentino Lima","doi":"10.1007/s10029-026-03744-1","DOIUrl":"10.1007/s10029-026-03744-1","url":null,"abstract":"<p><strong>Background: </strong>Closed-incision negative-pressure wound therapy (ciNPWT) has been shown to reduce complications in high-risk wounds, but there is still no consensus in literature to whether it is effective when compared to standard wound dressing (SWD). Therefore, we aimed to perform a systematic review and meta-analysis to assess the ongoing uncertainty regarding its clinical benefits.</p><p><strong>Methods: </strong>PubMed, Embase and Web of Sciences were systematically searched from inception to November 2025 for both observational and randomized studies comparing ciNPWT with SWD for patients submitted to abdominal wall reconstruction (AWR). A DerSimonian-Laird random-effect model and heterogeneity (assessed with Cochran's Q test and I² statistics) were performed using R software (version 4.4.0).</p><p><strong>Results: </strong>16 studies comprising 1,859 patients which underwent AWR, of whom 50% received ciNPWT and 50% SWD. The mean age was 56 years. The analysis showed that ciNTWT group presented significant reductions in both SSO (OR 0.56; 95%CI 0.36 to 0.86; p-value = 0.008; I² = 69.5%) and SSI (OR 0.61; 95%CI 0.39 to 0.91; p-value = 0.032; I² = 51.6%), no difference regarding readmission (OR 0.61; 95%CI 0.35 to 1.05; p-value = 0.072; I² = 26.5% ), reoperation (OR 0.69; 95%CI 0.39 to 1.23; p-value = 0.205; I² = 22.3%), hernia recurrence rates (OR 0.61; 95%CI 0.29 to 1.29; p-value = 0.1984; I² = 24.3%) and length of hospital stay (MD 0.26; 95%CI -1.22 to 1,75; p-value 0.729; I² = 92.1%).</p><p><strong>Conclusion: </strong>ciNPWT was associated with lower odds of SSI and SSO with no difference in LOS when compared to SWD.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653471","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":"Totally Endoscopic Sublay Anterior Repair (TESAR) for diastasis recti, primary and incisional ventral hernias: Long-term clinical outcomes and quality of life.","authors":"Federico Fiori, Francesco Ferrara, Carlo Corbellini, Lorenzo Gallitiello, Domenico Lo Conte, Marco Stella","doi":"10.1007/s10029-026-03808-2","DOIUrl":"10.1007/s10029-026-03808-2","url":null,"abstract":"<p><strong>Purpose: </strong>Abdominal midline defects, like diastasis recti (DR), primary and incisional ventral hernias, significantly impair function and quality of life. Minimally invasive abdominal wall reconstruction is increasingly shifting toward extraperitoneal approaches. This study aimed to evaluate the safety, efficacy, and long-term outcomes of Totally Endoscopic Sublay Anterior Repair (TESAR), an anterior completely extraperitoneal technique, through a retrospective observational analysis.</p><p><strong>Methods: </strong>Consecutive adult patients undergoing TESAR for DR and/or primary and/or incisional midline ventral hernias between January 2018 and March 2025 were included. The primary endpoint was the 30-day postoperative complication rate. Secondary endpoints included length of stay, recurrence, and quality of life (QoL), assessed by EuraHS-QoL and Carolinas Comfort Scale (CCS) up to 12 months. Recurrence was assessed clinically at scheduled visits or via telemedicine and by imaging (ultrasound or CT). The impact of technical refinements, including subcutaneous quilting suture, was analyzed.</p><p><strong>Results: </strong>A total of 120 patients were analyzed, with a median follow-up of 31 months. Indications included DR with umbilical hernia in 83 patients (69.2%), incisional hernias in 39 patients (32.5%), and other primary hernias in 15 patients (12.5%). No intraoperative complications occurred. Median follow-up was 31 months (range 12-81, IQR 18-54.5). Postoperative morbidity was 6.7% (seroma 5%, hematoma 1.6%), with no surgical site infections. No recurrences were clinically detected during follow-up. Quilting suture reduced clinically relevant seromas to 0%. Median hospital stay was 3 days. EuraHS-QoL scores improved from a median of 57 preoperatively to 0 at 12 months, and CCS scores from 35.5 to 0.</p><p><strong>Conclusion: </strong>TESAR appears to be a safe and effective minimally invasive technique for selected patients, associated with low morbidity and significant improvement in QoL. However, given the retrospective, observational and non-comparative design, these findings should be interpreted cautiously. Further prospective comparative studies are warranted.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630426","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}