Hernia[JOURNAL]
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200 papers
Preperitoneal extended totally extraperitoneal (PeTEP) repair for ventral hernia: A systematic review and meta-analysis.
Menegat ALRS, Menegat BLRS, Vergna RD … +4 more , Wagner B, de Oliveira Filho JR, de Figueiredo SMP, Ivano VK
Hernia · 2026 Jun · PMID 42228218 · Full text
PURPOSE: Ventral hernias are common abdominal wall defects associated with substantial healthcare burden and impaired quality of life. Minimally invasive extraperitoneal techniques have evolved to optimize midline recons...
PURPOSE: Ventral hernias are common abdominal wall defects associated with substantial healthcare burden and impaired quality of life. Minimally invasive extraperitoneal techniques have evolved to optimize midline reconstruction while avoiding intraperitoneal mesh placement, especially in the setting of diastasis recti. Preperitoneal Extended Totally Extraperitoneal (PeTEP) repair is a recently introduced approach, but evidence regarding its safety and effectiveness remains limited. Therefore, we performed a systematic review and meta-analysis to synthesize the available evidence. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies evaluating PeTEP repair for ventral hernia with or without rectus diastasis. Meta-analytical pooling of outcomes was performed using a random-effects model. All statistical analyses were conducted using R software (version 4.4.1). RESULTS: Four studies were included, comprising 99 patients, with a mean age of 51.53 years and a mean body mass index of 29.55 kg/m. The pooled mean operative time was 129.48 min (95% CI 74.96 to 184.00). Hematoma occurred in 10.61% of patients (95% CI 5.14 to 20.62), and overall postoperative complications in 21.21% (95% CI 12.98 to 32.69), with no intervention required in either case. Bulging was observed in 4.88% of cases (95% CI 1.22 to 17.52). No recurrences were reported across studies, with follow-up ranging from 1 to 12 months. CONCLUSION: Current evidence suggests that PeTEP may be a feasible minimally invasive extraperitoneal approach for ventral hernia repair. However, further comparative studies with longer follow-up are needed.
Comment to: Open inguinal hernia repair under combined transversalis fascia plane and transversus abdominis plane blocks in a high-risk cardiac patient.
Duyan AG, Koç MN
Hernia · 2026 Jun · PMID 42228204 · Publisher ↗
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The efectiveness of perioperative abdominal wall exercises upon functional recovery and return to work after Lichtenstein tension - free repair: a prospective randomized case -control study.
Trisca R, Oprea V, Toma M … +9 more , Cadar I, Bucuri CE, Finascu F, Andercou O, Bodog F, Matei IR, Siserman C, Chiroban O, Gherman C
Hernia · 2026 Jun · PMID 42228197 · Full text
BACKGROUND: Symptomatic groin hernias typically require surgical intervention, through either open or minimally invasive techniques. Among these, the Lichtenstein tension-free repair remains the gold standard for open pr...
BACKGROUND: Symptomatic groin hernias typically require surgical intervention, through either open or minimally invasive techniques. Among these, the Lichtenstein tension-free repair remains the gold standard for open procedures and is widely adopted today. Conventionally, patients are advised on convalescence and the timeline for resuming daily activities according with surgeons expertize. This study is based on the premise that structured physical rehabilitation can accelerate recovery and can facilitate an earlier return to work. Therefore, the goal was to evaluate the impact of a combined preoperative and post-operative exercise program as there is limited data that prehabilitation may decrease the period of convalescence. MATERIALS AND METHODS: A prospective randomized case -control study was conducted between January 1, 2023, and December 31, 2024, enrolling patients with primary unilateral reducible non-scrotal groin hernias. Participants were blindly randomised according to rehabilitation in a study group (receiving physical rehabilitation) and a control group (without rehabilitation). Baseline parameters including age, gender BMI (kg/m), comorbidities and symptoms onset were recorded for all participants. Preoperative hernia - induced disability was assessed using the Pain Disability Index (PDI).Abdominal wall functionality was evaluated through clinical validated tests: Trunk Raising (TR), Double Leg Lowering (DLL), and a Total Score (TS) calculated as the sum of TR and DLL. The assessments were performed preoperatively, as well as at 7 and 30 days postoperatively. Acute postoperative pain was recorded at 24 and 72 h using the Visual Analogue Scale (VAS). The primary endpoint was the time to return to work, assessing the overall impact of rehabilitation on convalescence. RESULTS: A total of 194 patients (97 per group) were analysed. Preoperatively, the study group exhibited significantly higher disability (PDI 56.7 ± 2.51 vs. 53.05 ± 2.74; p < 0.001) and lower abdominal functionality (AWF 5.15 ± 1.4 vs. 6.48 ± 1.34; p < 0.001) compared to controls, with baseline pain levels remaining similar (p = 0.937). Postoperatively, at 24 h, the control group experienced significantly higher VAS scores, particularly during mobilization (p < 0.001). By day 7, PDI reduction was markedly more pronounced in the rehabilitation group (18.48 ± 4.31 vs. 13.59 ± 3.83; p < 0.001), with a higher proportion of patients achieving the Minimal Important Change (61 vs. 42; p = 0.006). While AWF scores decreased significantly in controls by day 7 (p < 0.001), the study group maintained stability, reaching significantly higher mean AWF scores (7.77 ± 1.02 vs. 7.29 ± 0.92; p < 0.001) and superior functional recovery by day 30 (p = 0.01). Crucially, the rehabilitation group returned to work significantly earlier (9.28 ± 4.47 vs. 12.86 ± 5.16 days; p < 0.001). Multivariate regression identified preoperative PDI, functionality score, and symptom onset as independent predictors for both acute pain and early return to work (p < 0.05). During a mean follow-up of 18.4 ± 3.6 months, no recurrences were reported, and minor complications (hematoma, seroma, chronic pain) showed no significant differences between groups (p > 0.05), confirming the protocol's safety. CONCLUSIONS: Rehabilitation with physical therapy reduce disability, increase abdominal function and reduces the convalescence period after groin hernia repair in accordance with the actual guidelines.
Trisquel neoumbilicoplasty: three-flap spiral reconstruction in abdominal wall reconstruction patients.
Burciaga-Soto S, Mejía NAR
Hernia · 2026 Jun · PMID 42228183 · Publisher ↗
PURPOSE: Neoumbilical reconstruction after complex abdominoplasty or abdominal wall reconstruction (AWR) remains inadequately addressed by conventional techniques, which anchor cutaneous flaps to the anterior rectus fasc...
PURPOSE: Neoumbilical reconstruction after complex abdominoplasty or abdominal wall reconstruction (AWR) remains inadequately addressed by conventional techniques, which anchor cutaneous flaps to the anterior rectus fascia and require aggressive defatting to the deep fascia - principles incompatible with the presence of surgical mesh and with the compromised vascular territory of the post-abdominoplasty abdominal wall. We describe the Trisquel neoumbilicoplasty, a three-flap spiral technique designed to provide a reproducible and AWR-safe reconstructive option for high-risk patients in whom umbilical preservation is not feasible. METHODS: The technique is performed as a delayed procedure, no earlier than three months after the index operation, under local anesthesia in an office setting. A central 15 mm circle with three curvilinear arms at 120° separation is marked over the neoumbilical position. Three strictly cutaneous flaps are elevated in the plane of Camper's fascia, preserving the full thickness of subcutaneous fat and the subdermal vascular plexus. A central pocket is then created down to the deep surface of Scarpa's fascia, which is rigorously preserved as the anchoring substrate; the lateral cellular walls of the pocket are deliberately left intact. Three absorbable monofilament sutures invert and anchor each flap tip to Scarpa's fascia. A small intradermal antiseptic gauze bolster is secured in place with a tie-over suture and removed on postoperative day 5. RESULTS: The technique was performed in 15 consecutive patients (13 female, 2 male; mean age 45.9 ± 9.0 years; mean body mass index 27.4 ± 3.0 kg/m²), with a follow-up ranging from 22 to 46 months (mean 30.5 ± 6.6 months). Eight patients (53.3%) had previous polypropylene mesh placement for abdominal wall reconstruction. Flap viability was preserved in all cases, and no mesh-related complications, deep surgical site infections, reoperations, or cases of progressive flattening were observed. Minor complications occurred in 4 patients (26.7%), all of them mesh-bearing and with clustered high-risk features (active smoking, body mass index ≥ 30 kg/m², or diabetes mellitus); all four were limited subcutaneous seromas managed by percutaneous aspiration, without impact on the underlying hernia repair. Final morphological outcome was graded as excellent in 9 patients (60.0%) and good in 6 (40.0%). CONCLUSION: The Trisquel neoumbilicoplasty is a reproducible three-flap spiral technique specifically designed for the constraints of abdominal wall reconstruction. The three cutaneous flaps behave biologically as pedicled dermo-cutaneous grafts, an analogy borrowed from mucogingival and maxillofacial surgery that explains their consistent survival in compromised tissue beds. The technique offers a safe reconstructive option at the intersection of hernia surgery and body contouring, an area currently underserved by the neoumbilicoplasty literature.
Two-dimensional vs. three-dimensional laparoscopic transabdominal preperitoneal (TAPP) hernia repair: a systematic review and meta-analysis.
Elstohy A, Shelbaia FH, Elsobky M … +5 more , Ghriwati MN, Alghzawi HM, Sarah A, Hajajra AT, Deibes T
Hernia · 2026 May · PMID 42201585 · Publisher ↗
BACKGROUND: Two-dimensional (2D) laparoscopy provides limited depth perception, which may limit performance during technically demanding operations. Three-dimensional (3D) systems offer stereoscopic vision, improving vis...
BACKGROUND: Two-dimensional (2D) laparoscopy provides limited depth perception, which may limit performance during technically demanding operations. Three-dimensional (3D) systems offer stereoscopic vision, improving visualization. We compared 3D versus 2D systems in adults for operative time, visualization, and postoperative complications. METHODS: PubMed, Scopus, Web of Science, and Cochrane were searched through December 2025. We included randomized controlled trials and observational studies of patients undergoing TAPP repair, comparing 3D with 2D laparoscopy. Total operative time was the primary outcome; visualization and postoperative complications were secondary outcomes. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale, and certainty of evidence using GRADE. RESULTS: Six studies met the inclusion criteria; five were included in the primary meta-analysis (n = 521 patients). Total operative time favored 3D (MD-18.48 min; 95% CI-29.27,-7.69; p = 0.0008), with substantial heterogeneity (I²=94%). Subgroup analysis also favored 3D in RCTs (MD-11.70; 95% CI-17.74,-5.66) and observational studies (MD-26.85; 95% CI-30.55,-23.15). Contrast favored 3D (MD 2.11; 95% CI 0.56, 3.67; p = 0.008), while sharpness was not statistically different (MD 1.49; 95% CI-0.25 to 3.24; p = 0.09). No difference in postoperative complications (MD 1.11; 95% CI 0.75, 1.65; p = 0.59). CONCLUSION: 3D laparoscopy has been proposed to improve visualization and shorten operative time; however this should be interpreted with caution due to very low certainty of evidence and variability in surgeon experience. REGISTRATION/FUNDING: PROSPERO CRD420251272842.
Do patients scheduled for inguinal hernia repair express a preference for the repair technique? What questions do they frequently ask?
Bayar B, Süer MS, Devay AÖ … +2 more , Ölçücüoğlu E, Kulaçoğlu H
Hernia · 2026 May · PMID 42201563 · Publisher ↗
AIM: This study aimed to evaluate whether patients scheduled for elective inguinal hernia repair express a preference for the surgical technique prior to surgery, and to investigate the relationship of this preference wi...
AIM: This study aimed to evaluate whether patients scheduled for elective inguinal hernia repair express a preference for the surgical technique prior to surgery, and to investigate the relationship of this preference with perceived quality of information, the decision-making process, preoperative anxiety level, and information needs. METHODS: In this cross-sectional, observational, multicenter study, a total of 140 adult patients were included from three centers (one public and two private hospitals) (public: n = 70; private: n = 70). Data were collected using a preoperative patient questionnaire. The decision-making process was assessed using the Sure of Myself, Understand Information, Risk-Benefit Ratio, and Encouragement (SURE) scale, while anxiety and information needs were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Perceived quality of information and factors influencing surgical technique preference were evaluated using Likert scales. A surgical technique preference score and a perceived information score were calculated as composite indices. The primary outcome was whether the patient reported a preference regarding the surgical technique prior to surgery. RESULTS: Of the 140 patients, 86 (61.4%) reported a preference for the surgical technique; this rate was 72.9% (51/70) in private hospitals and 50.0% (35/70) in public hospitals (p = 0.040). Preference scores and perceived information scores were significantly higher in private hospitals (p < 0.001). Shared decision-making was more common in private hospitals, whereas surgeon-directed decision-making predominated in public hospitals (p = 0.012). The most influential factors affecting preference were expectations of postoperative pain and the risk of recurrence. When preoperative concerns were analyzed, patients in private hospitals more frequently inquired about postoperative comfort and functional recovery, whereas patients in public hospitals more often questioned whether the mesh (prosthetic material) could be harmful to the body. CONCLUSION: A substantial proportion of patients scheduled for elective inguinal hernia repair actively participate in the preoperative decision-making process and express a preference for the surgical technique. This preference is particularly associated with concerns about recurrence risk and postoperative pain, and patients' preoperative information needs differ according to the type of healthcare institution.
Validation of a rat parastomal hernia model for evaluating mesh biocompatibility and repair outcomes.
Zhu X, Liu J, Shen J … +3 more , Liu N, Zhong M, Tang R
Hernia · 2026 May · PMID 42201421 · Publisher ↗
PURPOSE: The preclinical evaluation of various meshes and surgical techniques for parastomal hernia (PSH) repair is limited due to the lack of a standardized, responsive, and clinically relevant animal model. This study...
PURPOSE: The preclinical evaluation of various meshes and surgical techniques for parastomal hernia (PSH) repair is limited due to the lack of a standardized, responsive, and clinically relevant animal model. This study aimed to validate a previously established rat PSH model and evaluate its ability to discriminate the biological and biomechanical properties of diverse meshes. METHODS: A total of 24 Sprague-Dawley rats were included in this study. A standardized PSH model was induced by a 3 × 2 cm abdominal wall defect, partial rectus abdominis resection, and functional end-colostomy. Keyhole repair was performed using biological meshes (porcine small intestinal submucosa [SIS] or porcine acellular dermal matrix [ADM]) or synthetic meshes (polyvinylidene fluoride [PVDF] or polypropylene [PP]). The model was validated using metrics such as survival, weight trends, and 8-week host responses, including recurrence/bulging, intestinal adhesion, erosion, inflammation, and angiogenesis. RESULTS: The model demonstrated excellent surgical feasibility and tolerance. All groups showed 100% survival and stable weight gain. The model sensitively discriminated mesh-specific outcomes. The SIS group exhibited significantly higher recurrence rates than that of the other groups. The ADM group showed minimal inflammation but moderate adhesion formation. Severe adhesions with histologically confirmed erosion into the stoma intestine were observed in the PVDF and PP groups. Significant differences in inflammation and angiogenesis were observed among the four groups. CONCLUSION: This rat PSH model provided a validated preclinical platform for evaluating PSH repair strategies and exhibited differential responses among the four meshes in biocompatibility and key repair outcomes.
The relationship between peak pressure and pulmonary complications in complex abdominal wall reconstruction.
Wijgers RA, Bakker SJ, Vreugde JPC … +3 more , de Vries Reilingh TS, Nienhuijs SW, Wegdam JA
Hernia · 2026 May · PMID 42201399 · Publisher ↗
PURPOSE: Complex abdominal wall repair (CAWR) increases intra-abdominal pressure (IAP), which may impair pulmonary mechanics that predispose patients to postoperative pulmonary complications (PPC). Intraoperative monitor...
PURPOSE: Complex abdominal wall repair (CAWR) increases intra-abdominal pressure (IAP), which may impair pulmonary mechanics that predispose patients to postoperative pulmonary complications (PPC). Intraoperative monitoring of pulmonary pressures may help assess PPC risk. Although pulmonary plateau pressure (Pplateau) is a known predictor of PPC, it is not routinely measured during surgery. Pulmonary peak inspiratory pressure (Ppeak) is continuously monitored and may serve as a practical alternative, but is not validated. This study aims to determine whether intraoperative Ppeak is associated with PPC after CAWR. METHODS: This retrospective cohort included 236 patients who underwent CAWR between 2016 and 2024. The difference in Ppeak immediately after anaesthetic induction and after abdominal wall closure (ΔPpeak) was recorded. Primary outcome was PPC, defined as pneumonia, atelectasis, pulmonary oedema, COPD/asthma exacerbation, or respiratory failure. Logistic regression identified predictors of PPC, and Receiver Operating Characteristic (ROC) analysis determined the discriminative threshold for ΔPpeak. Correlations between ΔPpeak and dynamic thoracic compliance were also evaluated. RESULTS: Median hernia width was 11 cm (IQR 9.0-15.0), median BMI 28 kg/m² (IQR 26.1-31.3), and 142 patients (60%) underwent component separation. PPC occurred in 79 patients (33.5%). ΔPpeak was independently associated with PPC (OR 1.13, p = 0.038). A threshold of ≥ 3.5 cmH₂O demonstrated 49% sensitivity and 69% specificity (AUC 0.60) for predicting PPC. ΔPpeak correlated negatively with dynamic thoracic compliance (r=-0.325, p < 0.001). CONCLUSION: Intraoperative ΔPpeak is independently associated with PPC following CAWR and may provide real-time intraoperative risk stratification. Prospective validation is required to confirm the predictive value compared to Pplateau.
Ventral incisional hernia repair after liver transplant using posterior component separation with transversus abdominis release.
Voidonikolas G, Leibowitz HG, Steggerda JA … +9 more , Frese J, Brennan T, Wisel SA, Todo T, Nissen N, Yang JD, Brazio PS, Kim I, Kosari K
Hernia · 2026 May · PMID 42189267 · Full text
PURPOSE: The optimal repair method for ventral incisional hernias (VIH) following orthotopic liver transplantation (OLT) has not been standardized. This study compares outcomes between use of open posterior component sep...
PURPOSE: The optimal repair method for ventral incisional hernias (VIH) following orthotopic liver transplantation (OLT) has not been standardized. This study compares outcomes between use of open posterior component separation with transversus abdominis release (PCS-TAR) versus other hernia repair techniques (OHR) in patients with prior OLT from a single center. METHODS: Patients with a prior OLT who underwent VIH repair along their trifurcation "Mercedes Benz" incision were identified at a single center between 2007 and 2022. The primary outcome of interest was incidence of hernia recurrence between patients who were treated with PCS-TAR versus OHR. Secondary outcomes included length of hospital stay (LOHS), surgical site complications (SSC), readmissions and reoperations. P values < 0.05 were considered significant. RESULTS: Of 1,083 OLTs, there were 53 VIHs (4.9%) repaired, of which 23 (43%) underwent PCS-TAR and 30 (56%) underwent OHR. There were no statistical differences in the demographics between the groups including mean age (62.7 vs. 58.6 years, p = 0.08), male sex (69.6% vs. 73.3%, p = 0.52), and BMI > 30 kg/m (21.7% vs. 30%, p = 0.5). The median time from OLT to VIH repair was 96 weeks vs. 99.3 weeks (p = 0.35). Median follow-up was shorter in the PCS-TAR group (53 vs. 88.5 months, p < 0.01). The mean hernia width was similar in the two groups (10.98 vs. 11.88 cm, p = 0.71). VIH recurrence was 0% in PCS-TAR compared to 36.7% in OHR group (p < 0.01). The two groups had similar incidence of SSC and LOHS. Unplanned reoperations were seen only in the OHR group (0% vs. 13.3%, p = 0.03). CONCLUSIONS: PCS-TAR repair with mesh is a superior technique for VIH repair following OLT, offering a safe and effective approach with reduced hernia recurrence compared to other repair techniques in post-OLT patients.
Mesh placement and risk of reoperation for recurrence after incisional hernia repair: a nationwide register-based cohort study.
Witthøft C, Ahmed U, Rosenberg J … +1 more , Baker JJ
Hernia · 2026 May · PMID 42184040 · Full text
PURPOSE: Retromuscular mesh placement is recommended for incisional hernia repair, but the current certainty of evidence remains low. This study aimed to compare the risk of reoperation for recurrence among adults underg...
PURPOSE: Retromuscular mesh placement is recommended for incisional hernia repair, but the current certainty of evidence remains low. This study aimed to compare the risk of reoperation for recurrence among adults undergoing incisional hernia repair with onlay, retromuscular, preperitoneal, and intraperitoneal onlay mesh (IPOM). METHODS: This study used prospectively collected data from the Danish Ventral Hernia Database that were linked to the Danish National Patient Register and the Danish Civil Registration System. We included patients undergoing elective incisional hernia repair with defect widths ≤ 10 cm operated between 2007 and 2025. The primary outcome was reoperation for recurrence, analyzed using Cox regression, and included subgroup analyses of defect width, surgical approach, and type of previous incision. RESULTS: In total, 5,375 patients were included, of whom 14% received a preperitoneal mesh placement, 22% retromuscular placement, 30% IPOM with defect closure, and 34% onlay placement. Compared with preperitoneal placement, onlay was associated with a higher risk of reoperation (HR 2.62, 95% CI 1.73-3.95; p < 0.001). Onlay was associated with a higher risk than all other placements. However, this association was not observed in subgroup analyses for defect widths ≤ 2 cm (p = 0.058), in which retromuscular placement was associated with a significantly increased risk of reoperation. CONCLUSION: Onlay mesh placement for defect widths > 2 cm and retromuscular mesh placement for defect widths ≤ 2 cm were associated with higher risk of reoperation for recurrence.
Comparative outcomes of laparoscopic intraperitoneal mesh implantation versus transabdominal preperitoneal repair for umbilical hernia: a retrospective cohort study.
Zhou J, Yu J, Li B
Hernia · 2026 May · PMID 42183928 · Publisher ↗
OBJECTIVE: This study aimed to compare the intraoperative and postoperative outcomes of laparoscopic intraperitoneal onlay mesh repair (IPOM) and transabdominal preperitoneal repair (TAPP) for adult umbilical hernia and...
OBJECTIVE: This study aimed to compare the intraoperative and postoperative outcomes of laparoscopic intraperitoneal onlay mesh repair (IPOM) and transabdominal preperitoneal repair (TAPP) for adult umbilical hernia and to provide clinical evidence for procedure selection. METHODS: We retrospectively reviewed adult patients with umbilical hernia who underwent laparoscopic IPOM or TAPP at a single tertiary referral center between July 2021 and July 2024. Baseline characteristics, operative variables, postoperative pain scores, and postoperative complications were compared between the two groups. RESULTS: A total of 69 patients were included, including 39 in the IPOM group and 30 in the TAPP group. Baseline characteristics were comparable between groups. The mean operative time was significantly longer in the TAPP group than in the IPOM group. However, postoperative VAS pain scores on the day of surgery and on postoperative days 1 and 7 were significantly lower in the TAPP group. No significant between-group differences were observed in intraoperative blood loss, length of hospital stay, postoperative complications, or recurrence during follow-up. CONCLUSION: Both laparoscopic IPOM and TAPP were safe and feasible for the treatment of adult umbilical hernia in this cohort. Although TAPP required a longer operative time, it was associated with lower short-term postoperative pain. No significant differences were observed in recurrence or complication rates. Larger prospective studies are needed to further clarify the comparative effectiveness of these two techniques.
Correction to: Preoperative weight loss for open abdominal wall reconstruction: study protocol for a randomized controlled trial.
Remulla D, Miles KS, Carvalho A … +8 more , Maskal SM, Butsch WS, Beffa LR, Petro CC, Krpata DM, Prabhu AS, Rosen MJ, Miller BT
Hernia · 2026 May · PMID 42183894 · Publisher ↗
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Renal consequences of complex abdominal wall reconstruction.
de Almeida Corrêa LM, Brandão LKV, Mazur GR … +5 more , Santiago CBG, de Assis Barbosa A, Dutra Júnior IF, Molinari GC, Fernandes CCS
Hernia · 2026 May · PMID 42171786 · Full text
PURPOSE: To review the renal consequences of complex abdominal wall reconstruction (AWR) and examine how reconstructive mechanics, intra-abdominal pressure, perioperative fluid strategy, and baseline renal reserve influe...
PURPOSE: To review the renal consequences of complex abdominal wall reconstruction (AWR) and examine how reconstructive mechanics, intra-abdominal pressure, perioperative fluid strategy, and baseline renal reserve influence postoperative kidney outcomes. METHODS: This focused narrative review searched PubMed/MEDLINE and Embase for studies published through March 2026 using terms related to abdominal wall reconstruction, complex ventral hernia repair, loss of domain, component separation, transversus abdominis release, intra-abdominal pressure, abdominal compartment syndrome, acute kidney injury, chronic kidney disease, renal dysfunction, and perioperative renal outcomes. Reference lists of key studies were also screened manually. RESULTS: Postoperative acute kidney injury after complex AWR is not uncommon and appears to cluster in patients with greater reconstructive intensity, particularly those undergoing large ventral hernia repair, major visceral reintegration, or transversus abdominis release. The available literature supports a clinically useful framework in which renal vulnerability after AWR reflects the interaction of pressure-related stress, hemodynamic and fluid-related factors, and limited baseline renal reserve. In selected patients, postoperative kidney injury may extend beyond the index admission. CONCLUSION: Complex AWR should be understood not only as an anatomic reconstruction but also as a physiologically demanding operation in which renal dysfunction may signal meaningful perioperative stress. For abdominal wall surgeons, this perspective supports more deliberate interpretation of postoperative oliguria, greater awareness of pressure-mediated organ dysfunction, and closer renal follow-up in high-risk patients.
To close or not to close the deep inguinal ring in laparoscopic hernia repair. A comparative study.
Rodriguez Piñero JN, Baz Gallego JJ, Gongora C … +3 more , Giacone Aguiar J, Valinoti AC, Sadava EE
Hernia · 2026 May · PMID 42166069 · Publisher ↗
PURPOSE: Closing the deep inguinal ring (DIR) in laparoscopic inguinal hernia repair (LIHR) is a potential alternative to improve surgical outcomes, however, its implementation remains controversial. We aimed to compare...
PURPOSE: Closing the deep inguinal ring (DIR) in laparoscopic inguinal hernia repair (LIHR) is a potential alternative to improve surgical outcomes, however, its implementation remains controversial. We aimed to compare postoperative results after DIR closure in laparoscopic TAPP repair for large indirect inguinal hernias. METHODS: A retrospective analysis was conducted in patients who underwent LIHR with indirect defects ≥ 3 cm (L3 according to the European Hernia Society classification) between January 2022 and December 2024. Patients were divided into two groups: closed ring repair (CRR) and standard repair (SR) group. Demographic, intraoperative, and postoperative variables were analyzed. RESULTS: A total of 177 laparoscopic TAPP repairs with L3 defects were included for analysis. Seventy-two repairs were in the CRR group and 105 in the SR group. Defect area was significantly larger in CRR group (CRR: 15.7 cm² vs. SR: 13.9 cm²; p = 0.02). Mesh fixation was less frequently required in CRR group (CRR: 56% vs. SR: 90.5%; p < 0.0001), and when fixation was used, fewer tackers were applied (CRR: 3.2 vs. SR: 4.7; p < 0.0001). Postoperative pain was significantly lower in CRR group at 1 week (VAS CR: 0.71 vs. SR: 1.63; p = 0.01) and at 1 month (VAS CRR: 0.19 vs. SR: 0.58; p = 0.04). After a mean follow-up of 15 (9-25) months, only one recurrence was observed in the SR group. CONCLUSIONS: Closing the deep inguinal ring in laparoscopic inguinal TAPP repair for L3 defects is safe. It was associated with a significant reduction of acute postoperative pain scores and mesh fixation requirements.
Effect of intraoperative crural block on first-day postoperative pain after laparoscopic hiatal hernia repair: a two-center retrospective study.
Ibayev R, Isgandarov U
Hernia · 2026 May · PMID 42159814 · Publisher ↗
Hiatal hernia repair is one of the most commonly performed surgical procedures for the treatment of gastroesophageal reflux disease (GERD), yet postoperative pain remains a clinically relevant issue despite the widesprea...
Hiatal hernia repair is one of the most commonly performed surgical procedures for the treatment of gastroesophageal reflux disease (GERD), yet postoperative pain remains a clinically relevant issue despite the widespread adoption of minimally invasive techniques. Dissection and suturing of the diaphragmatic crura may contribute significantly to early postoperative discomfort, and intraoperative local anesthetic infiltration of the crura under direct visualization has been proposed as a simple pain-modulating strategy. In this retrospective two-center study, 196 patients who underwent laparoscopic hiatal hernia repair between 2023 and 2025 were divided into two groups according to whether intraoperative crural infiltration with bupivacaine was performed. Postoperative pain during the first postoperative day was assessed using a visual analog scale (VAS; 0-10), and postoperative analgesic consumption was compared between groups. Patients who received intraoperative bupivacaine infiltration demonstrated significantly lower postoperative pain scores and reduced analgesic requirements compared with the control group, with statistical analysis performed using SPSS software revealing a significant difference between the groups (p < 0.001). These findings suggest that intraoperative bupivacaine infiltration of the diaphragmatic crura is a safe, simple, and effective adjunct technique for reducing early postoperative pain following laparoscopic hiatal hernia repair.
Emergency hernia hospitalizations in older adults with and without multimorbidity.
Liu Y, Collier K, Sharpe J … +5 more , Goldberg D, Hwang J, Okorji LM, Altieri MS, Kelz RR
Hernia · 2026 May · PMID 42159799 · Full text
PURPOSE: Hernia repairs have differences in outcomes based on hernia type. Information regarding hernia burden in the emergency setting is lacking. Among older adults, who have the greatest prevalence of hernia and the n...
PURPOSE: Hernia repairs have differences in outcomes based on hernia type. Information regarding hernia burden in the emergency setting is lacking. Among older adults, who have the greatest prevalence of hernia and the need for emergent repair, little data on the impact of multimorbidity on outcomes exist. We aim to define the burden of emergency hernia on hospitals and to compare outcomes of older adults with and without multimorbidity. METHODS: This was a nationwide retrospective cohort study of Medicare beneficiaries admitted emergently from 2015-2018 with a principal diagnosis of an umbilical, ventral, parastomal, femoral, or inguinal hernia. The primary outcome was all-cause inpatient mortality. Multivariable logistic regression was performed. RESULTS: Among 47,687 hospitalized patients, there were 4,612 (9.7%) umbilical, 17,707 (37.1%) ventral, 2,486 (5.2%) parastomal, 3,754 (7.9%) femoral, and 15,138 (31.7%) inguinal hernias. Multimorbidity was common (n = 24,393, 51.2%). Multimorbid patients had significantly higher rates of inpatient mortality (4.1% vs 1.1%), intensive care needs (48.6% vs 22.7%), discharge to a skilled nursing facility (SNF) (23.9% vs 11.7%), and 30-day readmission (22.0% vs 13.9%) than non-multimorbid patients. After adjustment, multimorbid patients had higher odds of death during index hospitalization (odds ratio = 1.98, CI: 1.53-2.56), intensive care needs (1.89, 1.74-2.06), and discharge to a SNF (1.52, 1.35-1.72) than non-multimorbid patients. Outcomes varied significantly based on hernia type. CONCLUSIONS: We define rates and outcomes of emergency hernia hospitalization in older adults across different hernia types and multimorbidity status. Multimorbid older adults hospitalized for ventral hernias had greatest risk of inpatient death. These data will permit improved patient counseling and shared-decision making for older patients admitted for emergency hernias across hernia types.
Quality and educational value of youtube videos on inguinal hernia surgery: a cross-sectional study.
Sayur V, Uc C, Baki B … +2 more , Guler E, Sezer TO
Hernia · 2026 May · PMID 42159796 · Publisher ↗
BACKGROUND AND AIM: With the increasing use of digital platforms in surgical education, YouTube has become a widely accessible resource for trainees. However, the absence of peer review raises concerns regarding the reli...
BACKGROUND AND AIM: With the increasing use of digital platforms in surgical education, YouTube has become a widely accessible resource for trainees. However, the absence of peer review raises concerns regarding the reliability and educational value of its content. This study aimed to evaluate the educational quality, reliability, and instructional value of inguinal hernia repair videos on YouTube using multiple validated scoring systems. MATERIALS AND METHODS: A systematic search was conducted on YouTube, and 50 videos meeting predefined inclusion criteria were analyzed. Videos were independently assessed by two blinded reviewers using the Global Quality Scale (GQS), Journal of the American Medical Association (JAMA) criteria, Video Power Index (VPI), Laparoscopic Video Educational Guidelines and Scoring (LAP-VEGaS), DISCERN, and Health on the Net (HONcode) criteria. Videos were also categorized according to their source. RESULTS: Of the 50 videos, 42% were uploaded by individual users and 36% by academic or institutional sources. Most videos demonstrated laparoscopic or robotic procedures. Median scores indicated moderate educational quality (GQS 3, JAMA 3, LAP-VEGaS 11). Videos categorized as originating from academic or institutional sources tended to achieve higher scores; however, these findings should be interpreted with caution. No significant correlation was found between video popularity (VPI) and educational quality. CONCLUSION: YouTube provides a widely accessible but variable educational resource for inguinal hernia surgery, with overall moderate quality even among selected videos. Video popularity alone does not reliably indicate educational value. Instead, viewers may benefit from prioritizing videos with structured step-by-step narration, clear visualization of key anatomical landmarks, transparent source identification, and inclusion of complication management. While YouTube may support learning as a supplementary tool, it may not adequately replace structured surgical training.
Is distance a barrier to postoperative follow-up? a cox proportion analysis of geographic, financial, and clinical factors in ventral hernia repair outcomes.
Balthazar da Silveira C, Dias Rasador A, Jensen RM … +8 more , Mardian T, Riley D, Leong K, Salevitz N, Janssen A, Deka V, Gillespie T, Ballecer C
Hernia · 2026 May · PMID 42159771 · Publisher ↗
INTRODUCTION: The adequate follow-up (FU) of patients undergoing ventral hernia repair (VHR) is crucial for both detecting recurrence and addressing health disparities. Loss to FU can significantly affect clinical outcom...
INTRODUCTION: The adequate follow-up (FU) of patients undergoing ventral hernia repair (VHR) is crucial for both detecting recurrence and addressing health disparities. Loss to FU can significantly affect clinical outcomes, as it hinders timely interventions and long-term monitoring. Factors such as demographic characteristics, comorbidities, socioeconomic status, and access to care may all influence the likelihood of loss of FU. We aimed to provide a time-dependent analysis of factors associated with the time of postoperative FU and factors influencing FU loss in a specialized hernia center. METHODS: Patients who underwent VHR between 2021 and 2023 were identified through medical chart review. Demographic, geographical, and clinical data were collected. FU was defined as days from surgery to the last office visit, and loss of FU was defined as failure to attend two consecutive scheduled clinic visits with no documented clinical contact for more than 6 months after the last visit. As a surrogate for social, financial, and geographical factors, the Distressed Communities Index (DCI) was used based on patients' ZIP codes. A Cox proportional hazards regression was used to analyze time-to-event data. Variables were selected based on clinical relevance as an exploratory analysis, including the DCI, out-of-city residency, sex, age, hospital length of stay (LOS), race, psychological diagnosis type of hernia, approach (robotic versus open), transversus abdominis release (TAR), hernia size, concomitant procedures, mesh use, postoperative emergency visits and reoperation, surgical site infection (SSI), surgical site occurrences (SSO), recurrence, chronic pain. Model assumptions were assessed, including proportional hazards. Hazard ratios (HR) and 95% confidence intervals (CI) were computed, and statistical significance was assessed using Wald tests. Model performance was evaluated with the concordance index (C-index). Kaplan Meier curves were built for factors identified as relevant for FU loss. All analyses were conducted using R. RESULTS: This study analyzed 264 ventral hernia repair patients (2021-2023; median age 56, BMI 30.3) to identify factors associated with post-operative FU loss. Baseline characteristics included 39.4% recurrent hernias and 22.7% with psychiatric conditions. Postoperative complications were low, but FU significantly declined over time (e.g., 53.0% at 1 year, 12.1% at 3 years). Unadjusted analyses showed open surgical approach, in-city residency, lower DCI, and a prior psychiatric diagnosis were associated with better FU. Multivariable Cox regression revealed that increased age reduced FU loss (HR 0.97). Geographic factors significantly impacted FU, with out-of-city residency (HR 1.82) and higher DCI (HR 1.74) both independently associated with increased FU discontinuation. CONCLUSION: Our findings suggest that the geographical, social, and financial factors represented by the DCI significantly influence the risk of the event. In addition, increased age was associated with reduced risk of FU loss, whereas out-of-city residency and higher DCI were associated with increased risk of FU discontinuation.
Impact of the SUture BIte TEchnique on clinical outcomes after midline laparotomy closure: SUBITE-a systematic review and meta-analysis.
Golling M, Baumann P, Kuger F … +1 more , Fortelny RH
Hernia · 2026 May · PMID 42154339 · Full text
BACKGROUND: The objective of this Systematic Review and Meta-Analysis (SR/MA) was to identify the best suture technique (short or large bites) for abdominal wall closure with respect to relevant outcome parameters such a...
BACKGROUND: The objective of this Systematic Review and Meta-Analysis (SR/MA) was to identify the best suture technique (short or large bites) for abdominal wall closure with respect to relevant outcome parameters such as incisional hernia (IH), surgical site infection (SSI) and linea alba (aponeurotic layer of the abdominal wall) dehiscence (LAD). METHODS: Registration was done in PROSPERO, a systematic literature search was performed in three data bases (PubMed, Embase and Cochrane). Randomised controlled (RCT) as well as non-randomised controlled trials (n-RCT) comparing the short (SB) versus large bite (LB) technique for abdominal wall closure after midline laparotomy were eligible for inclusion. Quality assessment was performed for RCTs (ROB) & n-RCTs (ROBINS-1, MINORS). The incidence of IH, SSI, LAD as well as the length of hospital stay (LOS) and time to close the linea alba (aponeurotic layer of the abdominal wall) were analysed as outcome parameters. Odds ratio with 95% confidence intervals were chosen to determine statistical significance. Heterogeneity was explored using the I-statistics and funnel plots evaluated a possible publication bias. RESULTS: This SR/MA comprised in total 5886 patients (large bite group 3339 vs. 2547 short bite group) enrolled in 7 RCTs and 5 n-RCTs. The SB-technique was associated with a significant lower IH, SSI, FD rate and a shorter LOS compared to the LB-technique (IH: Odds Ratio OR = 0.47 (95% CI 0.38-0.58; p < 0.00001; I = 11%)); SSI: OR = 0.53 (95% CI 0.42-0.67; p < 0.00001; I = 0%); FD: OR = 0.60 (95% CI 0.38-0.93; p = 0.02; I = 0%); LOS: Mean difference in days MD = -1.04 (95% CI -1.70, -0.37; p = 0.002; I = 13%), respectively). Furthermore, pooled effect estimates derived from RCTs were comparable to n-RCTs. No statistical relevant publication bias was detected, and the confidence of resulting evidence was high according to the validated GRADE tool. CONCLUSION: This systematic review and meta-analysis demonstrate consistent reductions in incisional hernia and surgical site infection with the small bites technique for midline laparotomy closure. The direction of effect is stable across randomized and comparative studies and supported by available long-term data. The clinical relevance and consistency of these findings support preferential use of the small bites technique in routine practice. The present evidence provides a robust basis for consideration in future updates of EHS abdominal wall closure guidelines. REGISTRATION: PROSPERO, registration number: CRD420251033244, registration date: 16th April 2025.
Complications after biosynthetic long-term absorbable mesh implantation for ventral hernia repair in clean and contaminated environments: a systematic review and meta-analysis.
Wieser M, van den Berg R, Romain B
Hernia · 2026 May · PMID 42133081 · Publisher ↗
BACKGROUND: Ventral hernia repair (VHR) remains a common yet complex surgical procedure, with substantial recurrence and complication rates. Long-term absorbable biosynthetic meshes have been introduced to provide tempor...
BACKGROUND: Ventral hernia repair (VHR) remains a common yet complex surgical procedure, with substantial recurrence and complication rates. Long-term absorbable biosynthetic meshes have been introduced to provide temporary reinforcement while potentially reducing mesh‑related morbidity. OBJECTIVE: This meta-analysis evaluates the safety and effectiveness of long-term absorbable biosynthetic meshes in VHR by synthesizing both comparative and descriptive studies. METHODS: Databases were searched up to October 2025 for studies on VHR with long-term absorbable biosynthetic mesh. Descriptive studies were pooled using random-effects models to determine event rates. Comparative studies were analyzed using odds-ratios (ORs). RESULTS: Thirty-five descriptive single-arm studies and seventeen comparative studies were included. Descriptive hernia recurrence rate was 11.6% (95%CI 9.3-14.3%), surgical site infection (SSI) 11.8% (95%CI 9.2-15.0%), surgical site occurrence (SSO) 21.9% (95%CI 15.9-29.5%), seroma 9.7% (95%CI 7.2-12.9%), and SSO/SSI requiring surgical-intervention (SSOPI) 9.7% (95%CI 7.6-12.3%). Mesh infection and explantation rates were 0.3% (95%CI 0.0-1.0%) and 0.5% (95%CI 0.0-1.6%) both also in single-arm studies. A significantly lower hazard of recurrence 0.47 (95%CI 0.24-0.93), and a non-significantly lower risk of SSI, SSO, mesh explantation, and SSOPI compared to biologic meshes was found in comparative studies. Absorbable meshes showed a non-significant difference in recurrence rate versus permanent synthetic mesh (OR 0.93, 95%CI 0.57-1.52) but significantly lower odds of mesh explantation (OR 0.46, 95%CI 0.27-0.79). CONCLUSIONS: Long-term absorbable biosynthetic meshes show low mesh infection and explantation rates in the available literature. Comparative analyses suggest lower recurrence versus biologic meshes and fewer explantations versus permanent synthetic meshes; however, these findings are based on heterogeneous, predominantly retrospective data with limited follow-up and should not be considered conclusive.
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