Hernia[JOURNAL]
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200 papers
Comment to: Seasonal trends in surgical site infections after hernia repair.
Liu H, Chen S, Zheng X
Hernia · 2026 Jun · PMID 42295504 · Publisher ↗
Abstract loading — click title to view on PubMed.
Endoscopic totally extraperitoneal repair for parastomal hernia using the ePauli technique.
Li J, Lu L, Yang Y … +3 more , Li Y, Shao X, Wu L
Hernia · 2026 Jun · PMID 42295480 · Publisher ↗
PURPOSE: This study aimed to evaluate the feasibility, safety, and short- to medium-term clinical outcomes of a standardized pure laparoscopic totally extraperitoneal (eTEP)-based endoscopic Pauli (ePauli) technique for...
PURPOSE: This study aimed to evaluate the feasibility, safety, and short- to medium-term clinical outcomes of a standardized pure laparoscopic totally extraperitoneal (eTEP)-based endoscopic Pauli (ePauli) technique for parastomal hernia (PH) repair. METHODS: A prospective analysis was conducted on 13 consecutive patients who underwent standardized eTEP-based ePauli repair for PH at our institution. Baseline clinical characteristics, perioperative parameters, and short- to medium-term postoperative outcomes were collected and analyzed. RESULTS: The cohort had a mean age of 72 ± 7.0 years (9 males, 4 females), with 61.5% classified as American Society of Anesthesiologists (ASA) grade 2 and 76.9% presenting with cardiovascular comorbidities. The mean PH defect diameter was 5.7 ± 1.6 cm, mean operative time was 245.9 ± 51.2 min, and median postoperative hospital stay was 7 days (range: 4-65 days). Postoperative complications included cholecystitis, surgical site infection, hematoma, and mesh infection (one case each, 7.7%), as well as intestinal obstruction (three cases, 23.1%). No seromas were observed. Two patients (15.4%) required secondary surgical intervention, and short-term recurrence was observed in one patient (7.7%) following mesh removal. All complications were successfully managed with targeted interventions, and all patients achieved uneventful recovery. CONCLUSIONS: The pure laparoscopic eTEP-based ePauli technique is a feasible and safe minimally invasive option for parastomal hernia repair, offering acceptable short- to medium-term outcomes. Although not universally applicable to all patients or surgeons, it constitutes a valuable and effective addition to the armamentarium for parastomal hernia repair.
Does mesh fixation reduce recurrence after laparoscopic inguinal hernia repair? A systematic review and meta-analysis.
Cordova-Nuñez C, Caballero-Alvarado J, Alva-Figueroa R … +1 more , Zavaleta-Corvera C
Hernia · 2026 Jun · PMID 42295469 · Publisher ↗
BACKGROUND: The role of mesh fixation during laparoscopic inguinal hernia repair remains controversial, particularly regarding its impact on recurrence and postoperative pain. This study aimed to compare the efficacy and...
BACKGROUND: The role of mesh fixation during laparoscopic inguinal hernia repair remains controversial, particularly regarding its impact on recurrence and postoperative pain. This study aimed to compare the efficacy and safety of mesh fixation versus non-fixation in laparoscopic inguinal hernia repair. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA 2020 guidelines. Databases including PubMed, Embase, Scopus, and Web of Science were searched from inception to January 2026. Adult patients undergoing laparoscopic inguinal hernia repair (TAPP or TEP) with mesh fixation versus non-fixation were included. The primary outcome was hernia recurrence. Secondary outcomes included early postoperative pain, chronic postoperative pain at six months, and mesh infection. Random-effects models were used to calculate pooled effect sizes. PROSPERO: CRD420261337928. RESULTS: Twenty RCTs comprising 1,537 patients (771 fixation vs. 766 non-fixation) were included. Mesh fixation was not associated with a significant reduction in hernia recurrence (RR = 0.58, 95% CI: 0.19-1.76; I² = 0%). Pooled analysis of early postoperative pain showed no statistically significant differences between groups; however, interpretation was limited by substantial heterogeneity across studies (MD = 0.24, 95% CI: -0.15 to 0.63; I² = 90.5%). No significant differences were observed in mesh infection rates (RR = 0.80, 95% CI: 0.18-3.59; I² = 17.9%). However, fixation was associated with increased chronic postoperative pain (MD = 0.27, 95% CI: 0.13-0.40; I² = 8.4%). CONCLUSIONS: Available evidence suggests that mesh non-fixation yields comparable short-term outcomes and may reduce chronic postoperative pain; however, current data remain insufficient to definitively exclude clinically meaningful differences in recurrence risk due to the low number of recurrence events reported across studies.
Favorable one-year outcomes despite residual fascial tension after ventral hernia repair with transversus abdominis release.
Han JJW, Bennett WC, Plaster JM … +10 more , Ellis RC, Carvalho AC, Lee J, Tastaldi L, Beffa LR, Krpata DM, Prabhu AS, Petro CC, Rosen MJ, Miller BT
Hernia · 2026 Jun · PMID 42295465 · Full text
PURPOSE: Fascial tension is thought to adversely impact herniorrhaphy, but the impact of residual tension on outcomes is uncharacterized beyond the immediate postoperative period. We previously reported fascial tension c...
PURPOSE: Fascial tension is thought to adversely impact herniorrhaphy, but the impact of residual tension on outcomes is uncharacterized beyond the immediate postoperative period. We previously reported fascial tension changes in a case series of patients who underwent posterior component separation with transversus abdominis release (PCS-TAR) and found no association between anterior fascia closure tension and early surgical outcomes. Here we consider patient outcomes at and beyond one postoperative year. METHODS: In this post-hoc analysis of a previously reported case series, surgical and patient-reported outcomes beyond one year were compared to the force (lbs) required to medialize anterior fascial elements before and after PCS-TAR. Patient demographics and surgical outcomes were captured in the Abdominal Core Health Quality Collaborative (ACHQC) registry, which was queried to identify surgical outcomes, including recurrence, wound morbidity, and patient-reported quality of life (QoL; hernia-specific and pain). Univariate regressions tested strength of association between fascial tension measures (baseline, closure, and intraoperative delta) and outcomes of interest. RESULTS: Of the 100 patients in the original case series, long-term clinical or patient-reported follow-up was available for 77. The long-term cohort had a median hernia width of 13 cm (IQR 10, 15), median baseline fascial tension of 11 lbs (IQR 6, 19) and median closure tension of 4 lbs (IQR 2, 8). Recurrence rate was 1.4% (n = 1) among those with clinical follow-up. No tension measures were associated with recurrence, wound morbidity, or patient-reported outcomes. CONCLUSIONS: In this exploratory analysis of 77 abdominal wall reconstruction operations with PCS-TAR, a near absence of adverse outcomes were observed at one year among cases with a median residual midline closure tension of 4 lbs. Hernia-specific QoL and pain were not associated increased closure tension. The analyses are markedly limited by low event rates but tentatively suggest safety within the observed range of residual tension measurements. Larger cohorts featuring higher tension measurements are necessary to substantiate the findings and identify an upper limit of 'safe' residual tension.
Operative time and recurrence across five techniques of inguinal hernia repair: a Bayesian network meta-analysis of 29 randomized trials.
Cao T, Deng M, Zeng D … +2 more , Li J, Wang X
Hernia · 2026 Jun · PMID 42295453 · Publisher ↗
PURPOSE: To benchmark the clinical efficiency and safety of five inguinal hernia repair techniques-open surgery, conventional laparoscopy (TAPP and TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted...
PURPOSE: To benchmark the clinical efficiency and safety of five inguinal hernia repair techniques-open surgery, conventional laparoscopy (TAPP and TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted TAPP (r-TAPP)-to guide evidence-based surgical decision-making. METHODS: Following PRISMA-NMA guidelines, we conducted a Bayesian network meta-analysis (NMA) of 29 randomized controlled trials (8,995 patients). Primary endpoints were operative time and recurrence; secondary outcomes included total complications and chronic pain. The certainty of evidence was systematically evaluated using the GRADE-NMA framework. RESULTS: Open repair and conventional laparoscopy remained the most time-efficient approaches. Compared with open repair, r-TAPP was associated with longer operative time (MD 23.84 min; 95% CrI 2.74-44.29), and TAPP showed a moderate time penalty (MD 14.42 min; 95% CrI 1.02-28.04). For hernia recurrence, the current network remained statistically underpowered to detect clinically meaningful differences among the five modalities; all recurrence estimates were imprecise, particularly for the sparse r-TAPP (OR 1.44; 95% CrI 0.03-83.86) and SILS nodes. Minimally invasive approaches showed a numerically favorable trend toward less chronic pain relative to open repair, although certainty for this subjective outcome remained limited. CONCLUSIONS: TEP provides the most favorable time-efficiency profile among minimally invasive options, while TAPP offers comparable safety with a moderate time penalty. However, we remain very uncertain about the effects of r-TAPP and SILS on recurrence and overall safety because of sparse-event data and very low-certainty evidence. The currently observed temporal penalty of r-TAPP in most general centers likely reflects early technology adoption and learning-curve effects rather than the ultimate ceiling of robotic efficiency. TRIAL REGISTRATION: PROSPERO (CRD420261306112).
BIO-A versus Phasix biosynthetic mesh in minimally invasive hiatal hernia repair: systematic review and meta-analysis.
Angeramo CA, Baz Gallego JJ, Sadava EE … +2 more , Herbella FAM, Schlottmann F
Hernia · 2026 Jun · PMID 42295448 · Publisher ↗
PURPOSE: Although surgical repair is the standard treatment for symptomatic large hiatal hernias, recurrence rates remain high. Biosynthetic meshes have been designed to reinforce the crural closure while minimizing mesh...
PURPOSE: Although surgical repair is the standard treatment for symptomatic large hiatal hernias, recurrence rates remain high. Biosynthetic meshes have been designed to reinforce the crural closure while minimizing mesh-related complications. The aim of this study was to compare surgical outcomes between two widely adopted biosynthetic prostheses for hiatal hernia repair (BIO-A and Phasix). METHODS: A systematic review of literature from January 1990 to July 2025 was conducted according to PRISMA guidelines. Studies reporting outcomes of minimally invasive hiatal hernia repair (HHR) with either BIO-A or Phasix were included. Main outcomes were symptom improvement, GERD-HRQL scores, proton pump inhibitor (PPI) use, and hernia recurrence. Secondary outcomes included mesh-related complications, overall and major morbidity, reoperation, and mortality. A meta-analysis of proportions and paired t-tests were performed. RESULTS: A total of 20 studies comprising 1,880 HHR procedures (BIO-A: n = 1,171 versus Phasix: n = 709) were analyzed. Mean follow-up was 26.5 and 29.6 months for BIO-A and Phasix studies, respectively. Both groups significantly improved symptoms (BIO-A: 65% to 16%, p = 0.003 vs. Phasix: 70% to 12%, p = 0.01), GERD-HRQL scores (BIO-A: 14.83 to 2.67 vs. Phasix: 18.40 to 4.40; p = 0.45), and reduced PPI use (BIO-A: 82% to 15% vs. Phasix: 84% to 10%; p = 0.75). Recurrence rates were similar between groups (BIO-A 9% vs. Phasix 7%, p = 0.63). Overall and major morbidity were also similar between groups (BIO-A: 10% and 0.7% vs. Phasix: 8% and 1.1%, respectively). CONCLUSION: Both prostheses were associated with favorable GERD-related outcomes, low surgical morbidity, and low recurrence rates after HHR. However, these findings should be interpreted cautiously, as between-group comparisons are exploratory and based on indirect evidence.
Long-term wound morbidity and hernia recurrence in diabetic patients with HbA1c ≥ 8.5% undergoing open transversus abdominis release: a descriptive longitudinal follow-up of a single-center cohort.
Kanani F, Zoabi N, Miller BT … +5 more , Beffa LR, Petro CC, Prabhu AS, Rosen MJ, Messer N
Hernia · 2026 Jun · PMID 42295428 · Full text
BACKGROUND: Preoperative glycemic control, as measured by HbA1c, is widely used in risk stratification for diabetic patients undergoing abdominal wall reconstruction (AWR). In a prior analysis, our group demonstrated tha...
BACKGROUND: Preoperative glycemic control, as measured by HbA1c, is widely used in risk stratification for diabetic patients undergoing abdominal wall reconstruction (AWR). In a prior analysis, our group demonstrated that among diabetic patients undergoing open ventral hernia repair (VHR) with transversus abdominis release (TAR), preoperative HbA1c levels did not correlate with short-term wound morbidity. This study evaluates long-term outcomes in patients with poor preoperative glycemic control (HbA1c ≥ 8.5%) undergoing open AWR with TAR. METHODS: Adult diabetic patients with HbA1c ≥ 8.5% who underwent open, elective, clean VHR with concurrent TAR and permanent synthetic mesh at the Cleveland Clinic Center for Abdominal Core Health between January 2014 and January 2024 were identified from the Abdominal Core Health Quality Collaborative (ACHQC) and followed for a minimum of 12 months. Assessed outcomes included wound morbidity, mesh-related complications, and hernia recurrence. Threshold analysis using ROC methodology and logistic spline regression was performed to evaluate the discriminative capacity of HbA1c within the poor glycemic control range. RESULTS: Of 48 patients with HbA1c ≥ 8.5%, 46 (95.8%) completed long-term follow-up at a median of 22.3 months. Long-term SSOPI and partial mesh removal rates were 4.3% and 2.2%, respectively. Pragmatic hernia recurrence was observed in 4 patients (8.7%), all of whom had experienced early wound morbidity (4/4); three of the four had also undergone partial mesh excision or removal (3/4). No recurrences were documented in patients with uncomplicated postoperative courses. Threshold analysis yielded an AUC of 0.37, indicating no meaningful discriminative threshold within the observed HbA1c range. CONCLUSION: Among diabetic patients with HbA1c ≥ 8.5% undergoing open AWR with TAR at a high-volume center, long-term wound and recurrence rates were within the range reported for general TAR cohorts. These descriptive findings, while limited by sample size and the absence of an internal comparator, support the hypothesis that preoperative HbA1c may have limited stand-alone discriminative capacity in this setting and warrant confirmation in adequately powered comparative analyses, including the longitudinal multi-stratum cohort currently ongoing at our institution.
The SWIFTSS hernia model: putting ultra-low-cost hernia simulation in everybody's hands.
Akhter Rahman MM, Kamara AA, Szymankiewicz M … +1 more , Hunt LM
Hernia · 2026 Jun · PMID 42295402 · Publisher ↗
PURPOSE: Low-cost hernia simulation models exist, but are commercially sold, use technology such as 3-D printing or have the manufacturing instructions behind pay-walls, rendering them beyond the reach of trainers in low...
PURPOSE: Low-cost hernia simulation models exist, but are commercially sold, use technology such as 3-D printing or have the manufacturing instructions behind pay-walls, rendering them beyond the reach of trainers in low-income countries. This perpetuates dependence on expatriate training missions. We designed an ultra-low-cost hernia training model using only materials readily available in low-resource settings supported by a freely available "You-tube style" how-to-make-it instructional video. METHODS: A prototype ultra-low-cost model was tested by surgical trainers and trainees in three low-income African countries and the UK. Both trainee and trainer end users were included in the innovation process throughout, amending features according to feedback. Emphasis was placed on anatomical accuracy, providing a platform for trainer instruction and trainee understanding. Test purchases of all necessary materials were made in provincial Sierra Leone. A step-by-step how-to-make-it video and downloadable pattern was created and shared free of charge online. Video link: https://tinyurl.com/2u9nnn6f or Pattern pieces: https://tinyurl.com/ycyhwt52 RESULTS: Test purchase indicated all materials are available in one of the world's poorest countries. The model was well received by trainees in Tanzania, Sierra Leone, Ghana and United Kingdom. CONCLUSION: Ultra-low-cost mesh hernia trainers have proved an important adjunct to training, but are currently out of reach of trainers in the world's poorest countries. The SWIFTSS model places the necessary information, within reach of anybody with a smart phone.
Comment to: Slowly absorbable suture for fascial defect closure in open incisional hernia mesh-repair is associated with decreased long-term recurrence.
Costa PA, Vaughn CC, Ondaera J … +1 more , Tripoloni DE
Hernia · 2026 Jun · PMID 42295396 · Publisher ↗
Abstract loading — click title to view on PubMed.
Open versus laparoscopic inguinal hernia repair in patients with obesity: a NSQIP propensity-matched analysis of 59,943 elective, emergency, and recurrent cases.
Hou M, Mitchell P, Debru E … +2 more , Church N, Meyer D
Hernia · 2026 Jun · PMID 42295395 · Publisher ↗
BACKGROUND: Laparoscopic inguinal hernia repair is increasingly used as an alternative to open repair. Our study investigates the 30-day outcomes of open vs. laparoscopic inguinal hernia repair in the population with obe...
BACKGROUND: Laparoscopic inguinal hernia repair is increasingly used as an alternative to open repair. Our study investigates the 30-day outcomes of open vs. laparoscopic inguinal hernia repair in the population with obesity using the National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: In this retrospective study, all patients with obesity who underwent inguinal hernia repair between the years 2015-2023 inclusive were selected from the ACS-NSQIP database. Patients who underwent open repair were matched with laparoscopic repair patients using propensity score. 30-day postoperative complication rates were compared between the open and laparoscopic groups including univariate and multivariate analysis. Subgroup analysis with emergency repair and recurrent hernia was conducted. RESULTS: There were 59,943 patients included including 30,289 patients undergoing open repair and 29,654 undergoing laparoscopic repair. The ratio of laparoscopic to open cases increased overall during the study period. The multivariate analysis showed a decreased rate of serious complication (OR 0.17, 95%CI 0.04-0.79). Furthermore, the multivariate analysis demonstrated odds ratio of serious complication of 0.63 (95%CI 0.34-1.17) in emergency repairs and 0.21 (95%CI 0.10-0.44) in recurrent cases when compared to open approach. CONCLUSION: Laparoscopic inguinal hernia repair in patients with obesity demonstrated a lower rate of postoperative serious complications in the all-comers and recurrent repair subgroup and was comparable to open repair for the emergency surgery subgroup. This study further supports the safety of laparoscopic inguinal hernia repair as an alternative to open repair in patients with obesity.
Minimally invasive extraperitoneal posterior neurectomy for anterior cutaneous nerve entrapment syndrome (ACNES): Primary description of the MEPONE technique and clinical outcomes.
Fischer R, Lambrecht J, Vogel R … +1 more , Mück B
Hernia · 2026 Jun · PMID 42295390 · Publisher ↗
BACKGROUND: Open anterior neurectomy for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) necessitates targeted dissection of the anterior rectus sheath, potentially compromising abdominal wall integrity. Utilizing e...
BACKGROUND: Open anterior neurectomy for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) necessitates targeted dissection of the anterior rectus sheath, potentially compromising abdominal wall integrity. Utilizing established eTEP (enhanced-view totally extraperitoneal) principles, this study introduces a novel minimally invasive extraperitoneal posterior neurectomy (MEPONE) technique. By accessing the retrorectus space, direct proximal nerve visualization is achieved while avoiding direct transfascial dissection at the entrapment site. METHODS: A retrospective, single-center analysis evaluated all patients who underwent MEPONE for conservatively refractory ACNES between May 2021 and October 2024 at Sykehuset Innlandet. The procedure mirrors the extraperitoneal dissection of eTEP ventral hernia repair to isolate and divide the intercostal nerve branches prior to their fascial penetration. Primary outcomes included operative times, abdominal wall-specific complications, and site-specific pain reduction (Numeric Rating Scale, NRS) at 3 and 12 months evaluated using Wilcoxon signed-rank tests. RESULTS: Twenty-one patients (14 female, 7 male) with a mean age of 44.4 ± 15.7 years and a mean BMI of 28.3 ± 6.1 kg/m² were included. A total of 24 neurectomies were performed (including 3 staged procedures). Mean operative time was 35.0 ± 9.3 min. The mean preoperative NRS score decreased significantly from 6.9 ± 1.6 to 1.5 ± 2.0 at 3 months (p < 0.0001) and 2.1 ± 2.0 at 12 months (p = 0.0007). Complete pain relief (NRS 0-1) was achieved in 9 patients (42.9%), with significant pain reduction (> 50%) in an additional 7 patients (33.3%). One patient presented with an asymptomatic relaxation of the rectus abdominis muscle (Clavien-Dindo Grade I). No major complications occurred. CONCLUSION: MEPONE is a safe and feasible technique for ACNES. It offers the advantages of minimally invasive surgery-avoiding peritoneal entry and minimizing soft tissue trauma-while delivering pain relief rates that fall within the range previously reported for open approaches, though comparative effectiveness remains unproven. It represents a valuable alternative in the surgical management of chronic abdominal wall pain.
Thirty-day outcomes of spinal versus general anesthesia for high-risk patients undergoing open inguinal hernia repair.
Li R, Tufano TP, Halpern AI … +4 more , Nanduru A, Kiankhooy A, Vaziri K, Noureldine SI
Hernia · 2026 Jun · PMID 42274837 · Publisher ↗
BACKGROUND: General anesthesia (GA) is the predominant choice for open inguinal hernia repair but may be associated with a higher risk of postoperative complications, particularly in patients with multiple comorbidities....
BACKGROUND: General anesthesia (GA) is the predominant choice for open inguinal hernia repair but may be associated with a higher risk of postoperative complications, particularly in patients with multiple comorbidities. Spinal anesthesia (SA) is therefore considered as an alternative for high-risk patients. However, its potential benefits in reducing postoperative complications remain unclear. This study aimed to compare 30-day outcomes between SA and GA in high-risk patients undergoing initial open inguinal hernia repair. METHODS: Patients who underwent initial open inguinal hernia repair were identified in the ACS-NSQIP database from 2005 to 2024. High-risk status was defined as a Modified Frailty Index (mFI) ≥3 and American Society of Anesthesiology (ASA) score ≥3. Exclusion criteria included emergency surgery, ventilator dependency, procedures not performed by general surgeons, cases with concomitant bowel resection, and cases where the primary anesthesia type was neither SA nor GA. A 1:1 propensity-score matching was performed to balance demographics and comorbidities between patients who received SA versus GA, and thirty-day outcomes were then compared. Additionally, a multivariable logistic regression analysis that included all high-risk patients was conducted to evaluate thirty-day outcomes while adjusting for all preoperative variables. RESULTS: A total of 118 high-risk patients underwent open inguinal hernia repair under SA, of whom 106 were successfully propensity-score matched to 106 of the 1,365 patients who received GA. After matching, 30-day mortality rates were comparable between SA and GA (0.94% vs. 0%, p = 1.00), as were rates of organ system complications, including cardiac (0.94% vs. 1.89%, p = 1.00), pulmonary (2.83% vs. 0.94%, p = 0.62), and renal complications (1.89% vs. 0%, p = 0.50). Operative time (63.44 ± 30.61 vs. 65.05 ± 30.74 min, p = 0.70), as well as length of stay for outpatient cases (0.28 ± 0.63 vs. 0.32 ± 0.95 days, p = 0.79) were comparable between SA and GA. All other 30-day outcomes were likewise comparable. Multivariable analysis confirmed that the 30-day outcomes of SA and GA were comparable for all high-risk patients. CONCLUSION: In high-risk patients undergoing open inguinal hernia repair, this study showed no evidence of a difference in 30-day outcomes between SA and GA; however, given the limited statistical power, these findings should not be interpreted as evidence of equivalence. The choice between SA and GA should therefore be guided by patient-specific factors, surgical complexity, and surgeon and center expertise. Further prospective studies are needed to validate these findings.
Improved quality of life after combined plastic and general surgical retromuscular mesh repair for abdominal wall hernia with concurrent rectus diastasis: a retrospective cohort study of 59 post-partum woman.
Smelt HJM, Driessen ICM, Berkvens E … +4 more , Hawinkels H, Nienhuijs SW, Wegdam JA, de Vries Reilingh TS
Hernia · 2026 Jun · PMID 42274807 · Publisher ↗
PURPOSE: To evaluate hernia recurrence, postoperative complications, and patient reported outcomes after combined open ventral hernia repair (OVHR) and rectus diast asis (RD) reconstruction with abdominal wall contour co...
PURPOSE: To evaluate hernia recurrence, postoperative complications, and patient reported outcomes after combined open ventral hernia repair (OVHR) and rectus diast asis (RD) reconstruction with abdominal wall contour correction in postpartum women. METHODS: This retrospective study included women (BMI < 30 kg/m2) with symptomatic ventral hernia ≥ 1 cm and concomitant RD ≥ 3 cm who underwent elective combined repair between 2018 and 2024. All patients had completed childbearing, experienced functional complaints, and maximized physiotherapy benefit. Primary outcomes were hernia recurrence and postoperative complications, classified as surgical site occurrences (SSO) and SSO requiring procedural intervention. Secondary outcomes included functional, physical, and cosmetic patient-reported outcomes. RESULTS: Fifty-nine patients were included. Wound-related complications occurred in 38.9%, mainly wound dehiscence (18.6%) and umbilical necrosis (13.6%). Wound infection occurred in 5.1%, with 3.4% requiring radiologic drainage and 1.7% reoperation. Significant postoperative improvements were observed in abdominal pain (93.2% to 15.3%, p < 0.001), back pain (64.4% to 3.4%, p < 0.001) abdominal swelling (59.3% to 5.1%, p < 0.001), abdominal wall dysfunction (100% to 8.5%, p < 0.001), and physical limitations (61.0% to 0%, p < 0.001). Dissatisfaction with abdominal aesthetics decreased from 100% preoperatively to 18.6% postoperatively (p < 0.001). No hernia recurrence occured. CONCLUSION: Combined OVHR and RD reconstruction in postpartum women results in substantial improvements in pain, function, and abdominal wall aesthetics without hernia recurrence. Despite notable wound-related complications, outcomes support the functional and quality-of-life benefits of a multidisciplinary surgical approach. Prospective studies are needed to confirm these findings and optimize perioperative strategies.
Analysis of morphological patterns in incisional hernias following different surgical approaches.
Hirohara M, H T, S U … +3 more , Y O, S S, N K
Hernia · 2026 Jun · PMID 42274806 · Publisher ↗
PURPOSE: Incisional hernia (IH) is a common complication after colorectal cancer surgery that can impair quality of life and require reoperation. However, the anatomical distribution of IH according to surgical approach...
PURPOSE: Incisional hernia (IH) is a common complication after colorectal cancer surgery that can impair quality of life and require reoperation. However, the anatomical distribution of IH according to surgical approach and the influence of patient-related factors on hernia morphology remain poorly characterized. METHODS: We retrospectively analyzed patients who underwent elective colorectal cancer surgery between 2009 and 2022, and included in the analysis the 464 patients who met the eligibility criteria. Patients were grouped by surgical approach: laparoscopic, upper-midline incision, or lower-midline incision. IH was diagnosed on postoperative computed tomography (CT) during at least 3 years of follow-up. Using CT data, spatial distribution, hernia midpoint (mean of the superior and inferior fascial margins) and longitudinal length were analyzed. Associations with clinical factors-including age, BMI, diabetes mellitus (DM), and pathological stage-were assessed using univariate and multivariable linear regression. RESULTS: IH developed in 82 of 464 patients (18%). Density mapping demonstrated approach-specific spatial patterns: after upper-midline incisions, hernias clustered predominantly in the European Hernia Society M3 region, whereas hernias following lower-midline incisions were concentrated below the arcuate line in the M4 region. Hernia midpoint was not associated with patient factors, whereas hernia length was independently associated with DM and advanced tumor stage in lower-midline incisions. CONCLUSIONS: IH after colorectal cancer surgery shows approach-specific anatomical patterns reflecting regional abdominal wall vulnerability. These findings support anatomically guided risk stratification and may inform region-specific closure and prevention strategies.
Comparison of the effects of two drug combinations: ropivacaine-dexmedetomidine and ropivacaine-ketamine administered subcutaneously for postoperative pain control in patients with inguinal hernia: a double-blind clinical trial.
Shojaei R, Kamali A, Eghbali Z … +1 more , Tavan H
Hernia · 2026 Jun · PMID 42274783 · Publisher ↗
INTRODUCTION: Postoperative pain management is a significant concern in surgery. This study aimed to compare the effects of two drug combinations, ropivacaine-dexmedetomidine and ropivacaine-ketamine, administered subcut...
INTRODUCTION: Postoperative pain management is a significant concern in surgery. This study aimed to compare the effects of two drug combinations, ropivacaine-dexmedetomidine and ropivacaine-ketamine, administered subcutaneously for postoperative pain control in patients undergoing inguinal hernia repair. MATERIALS AND METHODS: In this double-blind clinical trial, 140 patients scheduled for inguinal hernia surgery using the Lichtenstein technique at Valiasr Hospital in Arak were enrolled. They were randomly allocated into two treatment groups: dexmedetomidine + ropivacaine and ketamine + ropivacaine. The first group received dexmedetomidine 1 µg/kg plus ropivacaine 0.75% (3 mg/kg) diluted to a total volume of 10 mL with distilled water. The second group received ketamine 100 mg plus ropivacaine 0.75% (3 mg/kg) diluted to a total volume of 10 mL with distilled water. In both groups, subcutaneous injections were administered at the surgical incision site, which was then marked. Pain was assessed using the Visual Analog Scale (VAS) in the recovery room and at 2, 4, 6, 12, and 24 h postoperatively by a specialized surgical assistant. Changes in heart rate, mean arterial pressure, duration of analgesia, total opioid consumption, and complications were also recorded. Data were analyzed using SPSS version 20. RESULTS: The mean pain score was significantly lower in the dexmedetomidine + ropivacaine group compared to the ketamine + ropivacaine group (P < 0.001). The mean duration of analgesia was significantly shorter in the ketamine + ropivacaine group (P = 0.001). The mean opioid consumption was significantly higher in the ketamine + ropivacaine group (P = 0.01). CONCLUSION: Dexmedetomidine, compared to ketamine, provides superior pain reduction, prolongs analgesia duration, and decreases opioid requirements following inguinal hernia repair using the Lichtenstein technique.
Early inpatient patient-reported recovery experiences after open inguinal hernia repair in Pakistan: a qualitative phenomenological study.
Ikram A, Rehman A, Tariq M … +3 more , Hira RE, Ali M, Khan AA
Hernia · 2026 Jun · PMID 42268455 · Publisher ↗
PURPOSE: Successful inguinal hernia repair is usually measured by chronic post-operative pain severity, recurrence, and symptom resolution. These outcomes do not fully reflect patients' experiences and perceptions of rec...
PURPOSE: Successful inguinal hernia repair is usually measured by chronic post-operative pain severity, recurrence, and symptom resolution. These outcomes do not fully reflect patients' experiences and perceptions of recovery. This study explored patient-reported outcomes in the early post-operative period to provide insights for improving counselling, care, and patient satisfaction. METHODS: This qualitative phenomenological study was conducted in the surgical units of Aziz Fatimah Hospital, Pakistan, from August to December 2025. Patients aged 18-75 years without post-operative complications were recruited via purposive sampling. Following COREQ guidelines, semi-structured interviews were conducted with informed consent, audio recorded, and transcribed. Reflexive thematic analysis was performed concurrently until thematic saturation. RESULTS: Analysis unveiled four themes, i.e., Physical Recovery, Functional recovery and return to daily life, Psychological response, Surgery and recovery experience. Most patients reported experiencing mild to moderate post-operative pain; a few found it an acceptable part of healing, while a few reported no pain. Some patients reported tightness, backache, and sleeping difficulties. Patients desired to resume daily activities but avoid heavy lifting. Functional recovery varied. Anticipatory fears and concerns of patients were relieved by a smooth surgical experience. CONCLUSION: Patients' early postoperative experiences encompassed physical and functional recovery, psychological response, and surgical and recovery experience, revealing that recovery is a multidimensional process extending beyond pain resolution. This study highlights the functional, psychological, and emotional needs of patients that should be understood to improve patient care and satisfaction. Longitudinal studies can help understand patient experiences over a longer timeframe.
Hydrocele of the canal of nuck: a case series and literature review.
Co C, Wijerathne S, Dacaynos L … +4 more , Malik S, Loh C, Lee S, Lomanto D
Hernia · 2026 Jun · PMID 42268444 · Publisher ↗
INTRODUCTION: Hydrocele of the Canal of Nuck is a rare differential for a groin lump in females. It has a heterogeneity of presentations clinically: majority are associated with a groin hernia and most cases are incident...
INTRODUCTION: Hydrocele of the Canal of Nuck is a rare differential for a groin lump in females. It has a heterogeneity of presentations clinically: majority are associated with a groin hernia and most cases are incidentally discovered during pre-operative imaging for groin lumps in females. AIM: The purpose of this study is to discuss the clinical, radiological, histopathological findings, and the surgical treatment of this disease, with reference to prior published literature. METHOD: We report our experience on cases of hydroceles of the Canal of Nuck in female adults, treated at our hernia centre with open and laparoscopic approaches from 2013 to 2026. A literature review was performed to compare our experiences with previously reported cases. RESULTS: We reported 31 patients with hydrocele of Canal of Nuck. Twenty seven patients had pre-operative imaging with Ultrasound, Computed Tomography or Magnetic Resonance Imaging, which demonstrated the Canal of Nuck. The other four patients were incidental diagnoses made intra-operatively during inguinal hernia repair. All patients who had surgery with extra-peritoneal approach had concurrent indirect inguinal hernia which were repaired with a mesh in addition to the excision of the cyst. In two cases, multiple cysts were noted along the round ligament. All patients recovered well after surgery, with one having a seroma which resolved in 1 month. No complications or recurrence up to a minimum follow-up duration of 6 months. CONCLUSION: Hydrocele of Canal of Nuck is a rare condition. The differential diagnosis often includes more common causes of inguinal hernia. Most patients have associated indirect inguinal hernia or occult hernia, therefore an extra-peritoneal approach during exploration and excision of the cyst with concurrent mesh repair of the inguinal hernia is advisable to avoid future complications.
Short-term clinical outcomes of laparoscopic trans-abdominal pre-peritoneal repair using Parietex™ Lap.ProGrip™: a 10-year retrospective study.
Tahara S, Kimura T, Yamakawa J … +9 more , Akiyama S, Maruyama S, Ishihara N, Oura K, Matsuo C, Matsumoto T, Hashido N, Yoshida M, Fujita H
Hernia · 2026 Jun · PMID 42258003 · Publisher ↗
PURPOSE: The efficacy of self-fixating mesh in laparoscopic inguinal hernia repair remains controversial, and its use is not yet explicitly recommended by international guidelines. The short-term outcomes of patients who...
PURPOSE: The efficacy of self-fixating mesh in laparoscopic inguinal hernia repair remains controversial, and its use is not yet explicitly recommended by international guidelines. The short-term outcomes of patients who underwent trans-abdominal pre-peritoneal (TAPP) repair using Parietex™ Lap.ProGrip™ (Lap.ProGrip) during a 10-year period, were retrospectively analyzed, to evaluate its effectiveness at reducing recurrence and chronic post-operative inguinal pain (CPIP). METHODS: Data from 965 patients (1,129 hernias), aged ≥ 18 years, who underwent TAPP with Lap.ProGrip between November 2014 and October 2024, were retrieved. The standard post-operative follow-up period was 6 months. The primary endpoint was post-operative recurrence, specifically for large direct hernias (Japan Hernia Society [JHS] M3 type). The secondary endpoint was CPIP, which was defined, based on international guidelines, as pain that persisted for ≥ 3 months, required intervention, and interfered with daily activities. The intra-operative videos of all patients with CPIP were reviewed to identify potential procedural causes. RESULTS: The 6-month follow-up completion rate was 88.4%. Although 478 hernias (42.3%) had a defect size ≥ 3 cm, including 149 hernias (13.2%) of JHS M3 type, no early recurrences occurred. Four patients (0.5%) had CPIP. Intra-operative video review revealed that in three of the four patients, electrocautery for hemostasis within the "trapezoid of disaster" was performed, suggesting nerve injury, and no mesh-related displacement or folding was observed. CONCLUSIONS: The self-fixating mesh provides reliable short-term stability, even for large direct hernias. CPIP appears to be more closely associated with intra-operative hemostatic maneuvers than with the mesh.
Electromyographic and tomographic muscle changes after botulinum toxin administration through either 3 or 8 injection points in patients with large midline ventral hernias: a superiority study.
Espinosa-de-Los-Monteros A, Espinosa-Cruz V, Senties-Madrid H … +10 more , Lopez-Zamora Z, Escamilla-Diaz F, Mosqueda-Larrauri VL, Gamboa-Lopez CA, Bayliss-Amaya L, Machicado-Quispe D, Frayre-Garcia FJ, Vazquez-Zorrilla D, Ramirez J, Mendoza-Olivas L
Hernia · 2026 Jun · PMID 42257791 · Publisher ↗
PURPOSE: In this superiority study, the primary endpoint was to evaluate whether muscle changes in amplitude, thickness and length are superior when administering botulinum toxin to external and internal oblique muscles...
PURPOSE: In this superiority study, the primary endpoint was to evaluate whether muscle changes in amplitude, thickness and length are superior when administering botulinum toxin to external and internal oblique muscles using small volumes through 8 injection points compared to large volumes through 3 injection points in patients with large midline ventral hernias. A secondary endpoint was to assess new symptoms developed after injections. METHODS: Between March 2023 and July 2025, 31 patients with large midline ventral hernias underwent pre-habilitation with botulinum toxin injected to the external and internal oblique muscles. In each patient, a dose of 100 units of botulinum toxin was administered on the right side through 3 injection points using a volume of 48 cc, and the same dose was administered on the left side through 8 injection points using a volume of 16 cc. Muscle amplitude, thickness and length on each side were compared before and 4 weeks after injection using the Wilcoxon signed-ranked test for matched pairs. The changes seen between sides were compared using the Wilcoxon signed-ranked test and adjusted with the Benjamini-Hochberg false discovery rate method. RESULTS: Muscle amplitude decreased 52% on the 8-injection point side (from 275 µV to 121 µV; p = 0.003) and 50% on the 3-injection point side (from 259 µV to 129 µV vs.; p = 0.01) (95% CI between sides [-0.14, 0.27]; p = 0.14). Muscle thickness was reduced by 31% on the 8-injection point side (from 28 mm to 18 mm; p = 0.002) and 28% on the 3-injection point side (from 28 mm to 18 mm; p = 0.004) (95% CI between sides [-0.06, 0.09]; p = 0.89). Muscle length increased 26% on the 8-injection point side (from 113 mm to 154 mm; p = 0.001) and 15% on the 3-injection point side (from 124 mm to 139 mm; p = 0.003) (95% CI between sides [-0.13, 0.04]; p = 0.61). No new symptoms were recorded after botulinum toxin injections. CONCLUSION: In a group of patients with large midline ventral hernias, the degree of change in muscle amplitude, thickness and length was not superior when botulinum toxin was administered using small volumes through 8 injection points compared to large volumes through 3 injection points.
Environmental footprint of open versus laparoscopic inguinal hernia repair.
Herdwig A, Boulard P, Martin C … +4 more , Hemati S, Maulat C, Castel-Molières M, Muscari F
Hernia · 2026 Jun · PMID 42257724 · Publisher ↗
PURPOSE: To compare the environmental impact of ambulatory inguinal hernia repair performed using open surgery versus laparoscopy through a life cycle assessment (LCA). METHODS: A descriptive, prospective, non-interventi...
PURPOSE: To compare the environmental impact of ambulatory inguinal hernia repair performed using open surgery versus laparoscopy through a life cycle assessment (LCA). METHODS: A descriptive, prospective, non-interventional study was conducted at Toulouse University Hospital between October 2024 and February 2025. Intraoperative consumption of materials, energy, and medical devices was prospectively recorded in real time. Environmental impacts were quantified using a comprehensive LCA covering the full life cycle of all products used. The two surgical approaches were compared across 16 environmental impact categories of which the 8 most contributive were analyzed in detail. RESULTS: Laparoscopic repair was associated with a 1.44-fold higher environmental impact than open surgery, with an overall score of 4.67 x 10⁻³ versus 3.23 x 10⁻³, respectively. This difference corresponded to an additional 15.5 kg CO₂-equivalent emissions per procedure. Single-use non-woven materials and cotton-based products were the main contributors, whereas operating room energy consumption and sterilization of reusable devices contributed minimally. CONCLUSION: In ambulatory inguinal hernia repair, the choice of surgical approach has a substantial influence on environmental impact, underscoring the importance of integrating environmental considerations into operative decision-making.
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