Hernia[JOURNAL]
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200 papers
Can preoperative optimization improve abdominal wall surgery outcomes? a qualitative systematic review.
Eguchi M, de Macedo Torves M, Wilmsen C … +6 more , Duarte J, Nogueira R, Sanha V, Cavazzola L, Malcher F, Lima DL
Hernia · 2026 May · PMID 42096105 · Publisher ↗
BACKGROUND: Ventral hernia repair (VHR) is commonly performed in patients with multiple modifiable risk factors. Preoperative rehabilitation programs aim to optimize these risk factors and improve surgical outcomes; howe...
BACKGROUND: Ventral hernia repair (VHR) is commonly performed in patients with multiple modifiable risk factors. Preoperative rehabilitation programs aim to optimize these risk factors and improve surgical outcomes; however, their implementation and effectiveness remain variable. This systematic review evaluates current evidence on the role of preoperative optimization in patients undergoing VHR. MATERIALS AND METHODS: Cochrane Central, Embase, and PubMed were searched for studies comparing preoperative interventions versus standard care in patients undergoing VHR. The primary outcome was characterization of rehabilitation strategies. Secondary outcomes included surgical utilization, emergent repair, readmission, surgical site infection (SSI), surgical site occurrence (SSO), recurrence, reoperation, and mortality. RESULTS: Six studies were included, comprising a total of 3,556 patients, of whom 1,805 (50.7%) underwent preoperative optimization. Preoperative optimization interventions were highly heterogeneous and primarily consisted of multidisciplinary programs focused on exercise, weight loss, and lifestyle modification. Control groups varied widely, precluding formal meta-analysis. Studies requiring predefined optimization targets reported unsuccessful rehabilitation rates of 5.1%-45%. Emergent repair occurred in 6.8% of intervention patients in one study. SSI rates seemed lower and ranged from 4.2% to 11.8% in intervention groups versus 11.0%-16.7% in controls, SSO and reoperation rates were generally lower in optimization groups. CONCLUSION: Structured preoperative optimization pathways may be associated with improved short-term outcomes in select patients undergoing VHR. However, the current literature is heterogeneous, and standardized protocols and prospective studies are needed to better define optimal implementation strategies and long-term effectiveness.
Preoperative CT-based quantitative assessment of hernial SAC predicts early recurrence following primary hiatal hernia repair.
Ochiai T, Nakajima M, Nakagawa M … +8 more , Fujita J, Takise S, Ueta Y, Yoshimatsu M, Inoue N, Muroi H, Morita S, Kojima K
Hernia · 2026 May · PMID 42096069 · Full text
BACKGROUND: Recurrence of hiatal hernia after primary repair is a major concern, particularly early recurrence related to technical factors. Reliable preoperative predictors are essential for optimal surgical strategies....
BACKGROUND: Recurrence of hiatal hernia after primary repair is a major concern, particularly early recurrence related to technical factors. Reliable preoperative predictors are essential for optimal surgical strategies. Because the hernial sac area can also affect operative complexity, this study aimed to evaluate early recurrence-associated factors and their relationship with operative time using quantitative computed tomography (CT). METHODS: We retrospectively analyzed 48 patients who underwent laparoscopic hiatal hernia repair between July 2012 and July 2025. Preoperative CT was used to measure the maximum diameter and area of the hernial sac in the axial and coronal planes. We examined the association between these parameters and surgical outcomes including recurrence. RESULTS: Early recurrence was observed in four patients (8.3%), all of whom required reoperation within 3 days. Patients with early recurrence had longer operative times and larger axial hernial sac areas (p < 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the axial maximum diameter provided the highest predictive performance for early recurrence (area under the curve [AUC] = 0.89), with an optimal cutoff value of 117.6 mm. Other parameters, including axial area, coronal area, coronal diameter, and hiatal width, showed moderate predictive ability but none exceeded axial diameter accuracy. CONCLUSION: Axial hernial sac measurements are associated with early recurrence. Preoperative CT-based quantitative assessments may provide valuable information for predicting surgical complexity and recurrence, thereby supporting preoperative risk stratification and surgical planning. Therefore, prospective validation using a larger cohort is warranted.
Subject: submission of manuscript entitled "integrating eTEP ventral hernia repair into bariatric surgery: technical insights and clinical outcomes from an institutional experience".
Christopher PJ, S SK, Manchala A … +4 more , Xl JL, S P, Palanivelu PR, Chinnusamy P
Hernia · 2026 May · PMID 42096049 · Publisher ↗
BACKGROUND: Obesity is a well-established risk factor for ventral hernia, and concomitant repair during bariatric surgery offers the advantage of a single-stage solution. While the intraperitoneal onlay mesh (IPOM) techn...
BACKGROUND: Obesity is a well-established risk factor for ventral hernia, and concomitant repair during bariatric surgery offers the advantage of a single-stage solution. While the intraperitoneal onlay mesh (IPOM) technique has been the traditional approach, the enhanced-view totally extraperitoneal (eTEP) repair provides a biomechanically superior, retro-muscular alternative. However, its integration with bariatric surgery has not been previously described. OBJECTIVE: The primary objective of this study was to evaluate the feasibility and safety of integrating enhanced-view totally extraperitoneal (eTEP) ventral hernia repair into bariatric surgery and describing its technical nuances. Secondary objectives included reporting early hernia-related and metabolic outcomes. METHODS: A retrospective analysis was performed on 35 consecutive patients who underwent concomitant eTEP ventral hernia repair with bariatric procedures between July 2021 and January 2025. Of these, 23 underwent eTEP without transversus abdominis release (TAR) and 12 required TAR for posterior fascial closure. Bariatric procedures included laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis/mini-gastric bypass (OAGB-MGB). Perioperative outcomes, complications, and follow-up data were analyzed. RESULTS: Among 23 patients without TAR, 12 underwent LSG, 5 RYGB, and 6 MGB. Among the 12 TAR cases, 6 underwent LSG, 3 RYGB, and 3 MGB. The mean operative time was 157 ± 23 min, and the mean hospital stay was 3 ± 1 days. There were no intraoperative conversions or mesh-related infections. Two patients developed seroma managed conservatively. No hematomas, posterior rectus sheath ruptures, or recurrences were observed during a minimum follow-up of six months (mean 17 ± 3 months). CONCLUSIONS: This study demonstrates that concomitant eTEP ventral hernia repair can be safely integrated with bariatric surgery when performed in a standardized, contamination-safe manner. The detailed technical framework presented here provides a reproducible roadmap for surgeons adopting this approach in complex obese patients.
Outcomes of general anesthesia vs. local anesthesia with monitored anesthesia care for elective umbilical hernia repair in adults: a propensity score- matched analysis.
Huerta S, Phung C, McAllister J … +2 more , Tummala S, Tsai S
Hernia · 2026 May · PMID 42095994 · Full text
INTRODUCTION: There are no randomized controlled trials comparing general anesthesia (GA) to local anesthesia with monitored anesthesia care (LA + MAC) for adult patients undergoing elective umbilical hernia repair (UHR)...
INTRODUCTION: There are no randomized controlled trials comparing general anesthesia (GA) to local anesthesia with monitored anesthesia care (LA + MAC) for adult patients undergoing elective umbilical hernia repair (UHR). We hypothesized that LA + MAC would be associated with fewer postoperative complications without increasing recurrence. METHODS: A retrospective analysis of a prospectively maintained database was performed, including consecutive Veteran patients undergoing elective open primary UHR at a single institution between August 2005 and June 2025. Patients undergoing emergent repair, laparoscopic repair, incisional hernia repair, or epigastric hernia repair were excluded. Primary outcomes were recurrence, 30-day postoperative complications, and operative room times in patients receiving GA vs. LA + MAC. Variables significant on univariable analysis were included in a propensity score-matched analysis. RESULTS: A total of 602 patients underwent UHR with GA (n = 427) or LA + MAC (n = 175). PSMA yielded 143 patients in the GA and 175 patients in the LA + MAC group. In the unmatched cohort, recurrence was higher after GA than LA + MAC (4.7% vs. 1.1%, p < 0.01), but this difference was not significant after matching (2.8% vs. 1.1%, p = 0.30). Overall, 58 complications occurred (54 GA vs. 4 LA + MAC). In the unmatched cohort, complication rates were higher with GA (12.6% vs. 2.3%, p < 0.01), and this difference persisted after matching (9.8% vs. 2.3%, p < 0.01). Operative room time was modestly shorter with LA + MAC (mean difference = 5.3 min). CONCLUSIONS: LA + MAC was associated with significantly fewer postoperative complications and modestly shorter operative time, without increased recurrence. These findings support consideration of LA + MAC for elective open UHR.
Beyond the radiology report: a multi-criteria decision analysis to define essential CT parameters for abdominal wall reconstruction : STAMP-C framework for preoperative hernia imaging.
Kanani F, Zoabi N, Miller BT … +9 more , Beffa LRA, Petro CC, Prabhu AS, Lahat G, Nizri E, Lessing Y, Abu-Abeid A, Rosen MJ, Messer N
Hernia · 2026 May · PMID 42095962 · Full text
BACKGROUND: Comprehensive preoperative CT assessment is essential for ventral hernia repair, yet no standardized reporting framework exists. This study evaluated the completeness of preoperative abdominal CT reports and...
BACKGROUND: Comprehensive preoperative CT assessment is essential for ventral hernia repair, yet no standardized reporting framework exists. This study evaluated the completeness of preoperative abdominal CT reports and developed an evidence-based protocol to guide standardized reporting for abdominal wall reconstruction (AWR). METHODS: We conducted a systematic evaluation of CT reporting completeness in 834 patients who underwent elective transversus abdominis release (TAR) at the Cleveland Clinic Center for Abdominal Core Health between January 2020 and December 2024. A panel of AWR experts defined 16 CT-based parameters deemed essential for surgical planning, and their clinical relevance was validated through a global survey of 61 AWR surgeons. Radiologic reports were assessed for documentation of these parameters and compared with intraoperative findings and registry data from the Abdominal Core Health Quality Collaborative (ACHQC). Parameters were classified as either generalizable or patient specific. A Multi-Criteria Decision Analysis using the Analytic Hierarchy Process was applied to prioritize features for standardized reporting. RESULTS: Overall documentation completeness was limited, with a median of 34.4%. Although surgeons rated defect width as the most critical parameter for operative planning, it was documented in only 32.6% of CT reports. Patient-specific findings demonstrated higher overall reporting rates (median 87.8%), though key features such as mesh presence and anatomical mesh plane were documented in only 36.2% and 1.7% of applicable cases, respectively. Multi-Criteria Decision Analysis identified defect Size, Tanaka index, Anatomical hernia location, presence of prior Mesh, old mesh Plane and Concurrent inguinal or stomal site hernia as the most critical parameters for preoperative evaluation. CONCLUSION: Substantial gaps exist between CT reporting and the informational needs of AWR surgeons. We propose the "STAMP-C" framework as a pragmatic, consensus-driven model to standardize ventral hernia CT assessment and improve multidisciplinary alignment in preoperative planning. Prospective validation of this framework across diverse institutional settings and hernia subtypes is needed before universal adoption can be recommended.
Incisional hernia and the risk of incident depression: a population-based propensity score-matched cohort study.
Krieg A, Krieg S, Kostev K
Hernia · 2026 May · PMID 42095952 · Full text
PURPOSE: Incisional hernia is a common long-term complication of abdominal surgery and is traditionally seen as a structural defect. However, recent patient-centered research suggests that abdominal wall pathology may al...
PURPOSE: Incisional hernia is a common long-term complication of abdominal surgery and is traditionally seen as a structural defect. However, recent patient-centered research suggests that abdominal wall pathology may also impose substantial psychological burden. Whether incisional hernia is associated with an increased risk of clinically diagnosed depression at the population level remains unclear. METHODS: This retrospective cohort study used data from the German Disease Analyzer database (IQVIA). Adults with a first documented diagnosis of incisional hernia (ICD-10: K43.0-K43.2) between 2005 and 2024 were identified. Individuals with recent psychiatric disorders were excluded to assess incident depression. Patients were matched 1:1 to controls without hernia using propensity scores based on age, sex, index year, consultation frequency, somatic comorbidities, and remote history of depression. The primary outcome was incident depression (ICD-10: F32, F33) within five years. Associations were analyzed using conditional Cox regression. RESULTS: A total of 10,075 patients with incisional hernia were matched to 10,075 patients without hernia. During five years of follow-up, 18.4% of patients with and 16.5% without incisional hernia were diagnosed with depression. Incisional hernia was associated with a slightly increased risk of incident depression (hazard ratio 1.12; 95% confidence interval 1.04-1.20). The association was more pronounced among women and among individuals without prior depression. CONCLUSION: Incisional hernia is associated with a slightly increased risk of clinically diagnosed depression. These findings indicate a modest statistical association between incisional hernia and subsequent depression diagnoses in routine care. While the magnitude of the association was small, awareness of potential psychosocial comorbidity may be relevant in selected clinical contexts.
Parainguinal or spigelian hernia: a clinically important distinction. Author's Reply.
Yu S, MBiostat NB, Dodds N … +4 more , Sweeney E, Wickins S, Glover A, Hugh TJ
Hernia · 2026 May · PMID 42095937 · Publisher ↗
Abstract loading — click title to view on PubMed.
Midline single-port eTEP stoppa repair for bilateral inguinal hernia: How I do it.
Konishi Y, Kobayashi T, Shoji H … +3 more , Kasai H, Kawamura H, Taketomi A
Hernia · 2026 May · PMID 42095932 · Publisher ↗
BACKGROUND: Early bilateral extraperitoneal unification through a midline single-port eTEP approach enables the creation of a wide, continuous lower abdominal working cavity without crossover manipulation. We evaluated t...
BACKGROUND: Early bilateral extraperitoneal unification through a midline single-port eTEP approach enables the creation of a wide, continuous lower abdominal working cavity without crossover manipulation. We evaluated the feasibility and outcomes of this technique for primary bilateral inguinal hernia repair. METHODS: This retrospective case series represents the complete institutional experience with midline single-port eTEP Stoppa repair between January 2020 and December 2025. Primary bilateral hernias were included; recurrent, incarcerated, and large scrotal hernias were excluded. Operative outcomes, complications (Clavien-Dindo classification), and follow-up data were analyzed. SURGICAL TECHNIQUE: Through a transverse infraumbilical midline incision, the bilateral retrorectus and preperitoneal spaces are unified at the beginning of the procedure, and a single-port device is inserted to establish a wide extraperitoneal working cavity. Bilateral inguinal dissection is then performed without crossover manipulation, followed by deployment of a single large mesh according to Stoppa principles. RESULTS: Forty-four consecutive patients underwent the procedure. Median operative time was 121 min. No conversions occurred. Intraoperative peritoneal injury occurred in 12 patients and was repaired laparoscopically. No Clavien-Dindo grade ≥ II complications were observed. Median length of stay was 2 days (range 1-3). Median follow-up was 565 days (IQR 287-1050), with no recurrences or incisional hernias detected. CONCLUSIONS: Midline single-port eTEP Stoppa repair establishes early bilateral extraperitoneal continuity, creating a wide lower abdominal operative field and eliminating crossover manipulation. This technique may represent a structurally distinct alternative to conventional bilateral TEP and may offer potential ergonomic advantages.
Clinical examination of musculoskeletal groin pain: a simple protocol for hernia surgeons (Groin-MAP).
O'Connor D, MBiostat NB, Turner A … +1 more , Hugh TJ
Hernia · 2026 May · PMID 42089938 · Publisher ↗
PURPOSE: Patients with groin pain are often referred to hernia surgeons because of imaging-detected inguinal abnormalities, even when no hernia is palpable. Many of these patients have musculoskeletal pathology that woul...
PURPOSE: Patients with groin pain are often referred to hernia surgeons because of imaging-detected inguinal abnormalities, even when no hernia is palpable. Many of these patients have musculoskeletal pathology that would not benefit from surgical intervention. This project aimed to develop a rapid, evidence-informed musculoskeletal screening protocol for use as an adjunct to routine hernia assessment. METHODS: The protocol was developed in four phases: (1) Structured PubMed search for clinical examination tests relevant to each of the entities defined by the 2016 Doha agreement classification system; (2) QUADAS-2 appraisal and extraction of individual tests based on reliability, diagnostic accuracy, and prevalence; (3) consultation with a sports physiotherapist and a high-volume hernia surgeon; and (4) protocol synthesis. RESULTS: From seven eligible studies, 79 techniques were considered. Thirteen fulfilled our criteria for diagnostic utility and were refined into a six-item protocol. This was titled the Groin Musculoskeletal Assessment Protocol (Groin-MAP). The Groin-MAP screens for adductor-, pubic-, iliopsoas-, and hip-related groin pain. The protocol prioritises low-intra-abdominal-pressure manoeuvres and can be completed in approximately 100 s during simulated testing. CONCLUSION: Groin-MAP is a fast and simple musculoskeletal screening adjunct to routine hernia assessment. It requires no equipment or pre-requisite knowledge and clearly explains each test and the positioning of the patient and clinician. Prospective validation will be required to determine its diagnostic performance and impact on clinical decision making.
Risk factors for postoperative seroma after TEP inguinal hernia repair: a retrospective analysis of 477 patients.
Ozyalvac FT, Sahin N, Donmez T … +5 more , Canoz O, Ozturk MM, Berksel DE, Gumusoglu AY, Surek A
Hernia · 2026 Apr · PMID 42060006 · Publisher ↗
BACKGROUND: Postoperative seroma remains one of the most common early complications after laparoscopic inguinal hernia repair. Although total extraperitoneal (TEP) repair is widely used due to favorable outcomes, data on...
BACKGROUND: Postoperative seroma remains one of the most common early complications after laparoscopic inguinal hernia repair. Although total extraperitoneal (TEP) repair is widely used due to favorable outcomes, data on independent predictors of seroma formation are inconsistent, and large single-center analyses with standardized technique are limited. METHODS: This retrospective study included 477 adult patients who underwent elective TEP inguinal hernia repair between January 2018 and December 2024 at a tertiary referral center. Seroma was defined as a clinically evident fluid collection within 30 days postoperatively and was confirmed by ultrasonography. Demographic, clinical, and operative variables were evaluated. Variables associated with seroma in univariate analysis were included in multivariate logistic regression. RESULTS: Postoperative seroma developed in 48 patients (10.1%). In the univariate analysis, higher body mass index (BMI), recurrent hernia, bilateral hernia, scrotal hernia, longer operative time, and conversion to open surgery were significantly associated with seroma formation. In the multivariate analysis, scrotal hernia (OR 5.85; 95% CI 2.03-16.85; p = 0.001) and bilateral hernia (OR 1.67; 95% CI 1.09-2.55; p = 0.018) were identified as independent risk factors. Primary hernia was associated with a significantly lower risk of seroma formation (OR 0.342; 95% CI 0.159-0.732; p = 0.006), indicating that recurrent hernia represents an independent risk factor. BMI did not remain significant after adjustment. CONCLUSION: Seroma formation after TEP repair is mainly driven by anatomical and technical factors. Scrotal hernia, bilateral repair, and recurrent hernia represent high-risk features and should be considered during preoperative risk assessment and perioperative planning.
Association between umbilicus-symphysis pubis distance and operative time in transabdominal preperitoneal (TAPP) inguinal hernia repair.
Gülçek E, Aydoğdu YF, Özaydın S … +1 more , Büyükkasap Ç
Hernia · 2026 Apr · PMID 42053697 · Full text
BACKGROUND: The transabdominal preperitoneal (TAPP) approach is a widely used minimally invasive technique for laparoscopic inguinal hernia repair. However, operative time and technical difficulty may vary depending on p...
BACKGROUND: The transabdominal preperitoneal (TAPP) approach is a widely used minimally invasive technique for laparoscopic inguinal hernia repair. However, operative time and technical difficulty may vary depending on patient-related anatomical factors. This study evaluated the effect of the umbilicus–symphysis pubis (USP) distance on operative time and investigated whether this superficial anatomical measurement could guide patient selection. METHODS: In this retrospective study, data from 767 patients who underwent TAPP repair at Gazi University Hospital between January 2015 and June 2022 were reviewed. After applying the exclusion criteria, 341 male patients were included. Of these, 272 had unilateral and 69 had bilateral inguinal hernia. The distance between the umbilicus and symphysis pubis was measured preoperatively in all patients. The relationship between USP distance and operative time was analyzed using the Python-based Maximally Selected Rank Statistics (MaxStat) method, and optimal cut-off values were determined. RESULTS: The age range of the study group was 18.00–77.00 years, with a median age of 44.00 years. The USP distance ranged from 9.70 to 23.50 cm in unilateral cases and from 11.10 to 22.30 cm in bilateral cases. MaxStat analysis identified optimal cut-off values of 15 cm for unilateral and 16 cm for bilateral hernia cases. In unilateral cases, operative time was significantly longer in patients with a USP distance ≤ 15 cm (p < 0.001). Similarly, in bilateral cases, operative times were significantly longer when the USP distance was ≤ 16 cm (p < 0.001). CONCLUSION: USP distance may serve as a simple and easily measurable anatomical parameter associated with surgical duration, particularly in unilateral TAPP repairs. As patients with a shorter USP distance were associated with longer operative times, this association warrants further prospective validation before USP distance can be considered a routine parameter in preoperative planning.
Does the Type of Permanent Mesh Matter for Inguinal Hernia Repair?
Mahajan NN, Heh V, Buchely N … +1 more , Sreeramoju P
Hernia · 2026 Apr · PMID 42047873 · Full text
INTRODUCTION: Inguinal hernia repair (IHR) is one of the most performed general surgery procedures in the United States, with more than 700,000 cases annually. There are limited data on the clinical outcomes based on the...
INTRODUCTION: Inguinal hernia repair (IHR) is one of the most performed general surgery procedures in the United States, with more than 700,000 cases annually. There are limited data on the clinical outcomes based on the type of mesh (polyester or polypropylene) used in IHR. This study aims to bridge the knowledge gap on clinical outcomes for polyester and polypropylene mesh used for open and minimally invasive IHR. PATIENTS AND METHODS: A retrospective review of prospectively collected data from Abdominal Core Health Quality Collaborative (ACHQC) of all adult patients (Age ≥ 18 and ≤ 90 years) who underwent initial elective IHR (2014–2024) with or without mesh. Univariate and multivariate analyses were performed comparing mesh-based repair with no-mesh repair as the control group. RESULTS: From 37,262 patients with initial elective IHR, 25,331 had polypropylene mesh, 8391 had polyester mesh, and 1770 had no-mesh repair. At 30-day follow-up, polypropylene and polyester had lower readmission (0.8% and 0.7% vs 1.3%;p < 0.05) but higher surgical site occurrences (SSO) (5.3% and 5.5% vs 2.2%;p < 0.05) compared to no-mesh repair. At 1-year follow-up, polypropylene and polyester had lower recurrence compared to no-mesh repair (6.4% and 6.6% vs 11%; p < 0.05). Additional analyses demonstrated similarly lower recurrence with polyester mesh. On logistic regression, polyester (OR 0.4,CI 0.28–0.69) and polypropylene (OR 0.4,CI 0.27–0.57) were protective against recurrence with similar SSO for polyester (OR 1.9,CI 1.01–3.51) and polypropylene (OR 1.9,CI 1.06–3.51) compared to no-mesh repair. Polyester (OR 0.4,CI 0.31–0.56) and polypropylene (OR 0.5,CI 0.39–0.65) had lower ≥6-month EuraHS-QoL pain score compared to no-mesh repair. No statistically significant difference for polyester versus polypropylene based on surgical approach. CONCLUSION: There was no difference in the 30-day SSO or 1-year hernia recurrence for polyester and polypropylene, irrespective of the surgical approach. Contrary to generalized belief, synthetic mesh-based posterior approach repair may be protective against chronic pain. This highlights the need to focus on surgeon preference and resource utilization that could impact practice guidelines.
Seasonal trends in surgical site infections after hernia repair.
Sethurathnam J, Wang CC, Ewing J … +2 more , Khan A, Bradley JF
Hernia · 2026 Apr · PMID 42047871 · Full text
PURPOSE: Surgical site infections (SSIs) after hernia repair are associated with longer hospital stays, increased readmission rates, and higher hospital costs. Patients undergoing colorectal and orthopedic surgeries duri...
PURPOSE: Surgical site infections (SSIs) after hernia repair are associated with longer hospital stays, increased readmission rates, and higher hospital costs. Patients undergoing colorectal and orthopedic surgeries during warmer months have been shown to have higher SSI risk. We investigated the relationship between season and SSI risk after hernia repair, hypothesizing that SSI risk is higher during warmer months. METHODS: This retrospective cohort study used the American College of Surgeons (ACS) – National Surgical Quality Improvement Program (NSQIP) database to identify hernia repair patients from 2006 to 2021. We compared rates of any SSI between warm and cold seasons, defined based on admission quarter. Multi-variable and binomial logistic regression models were used to determine independent predictors of outcomes. RESULTS: Of the 826,636 patients in the final cohort, 400,329 (48.4%) underwent surgery in the warm operative season. Warm operative season was associated with increased odds of superficial [OR 1.15 95% CI 1.10–1.20] (+ 1.11 SSIs per 1000 cases) and any [OR 1.12 95% CI 1.08–1.16] SSI (+ 1.30 SSIs per 1000 cases) after adjusting for covariates. There was no difference between seasons for rates of deep incisional [OR 1.04 95% CI 0.96–1.13] and organ space [OR 1.02 95% CI 0.93–1.12] SSIs. Other independent predictors of any SSI included open surgical approach, groin hernia, non-elective case type, smoking, diabetes, and obesity. CONCLUSIONS: Patients undergoing hernia repair in warmer months have a higher risk of superficial SSI compared to those in colder months. Season may represent an under-explored SSI risk factor and warrants further study to identify modifiable mechanisms.
Hernia recurrence after concomitant laparoscopic ventral hernia repair using intraperitoneal biologic mesh: a retrospective analysis.
Hlavin C, Donohue JK, Mayer N … +5 more , Lu L, Bernardi K, Brown J, Neal MD, Courcoulas A
Hernia · 2026 Apr · PMID 42047866 · Publisher ↗
PURPOSE: Evidence is compelling for the safety and acceptable short-term outcomes of concomitant bariatric surgery (BS) and laparoscopic ventral hernia repair (LVHR). No studies have examined patient characteristics that...
PURPOSE: Evidence is compelling for the safety and acceptable short-term outcomes of concomitant bariatric surgery (BS) and laparoscopic ventral hernia repair (LVHR). No studies have examined patient characteristics that may guide selection between concomitant LVHR and staged operations in patients undergoing laparoscopic Roux-en-Y (LRNY) or sleeve gastrectomy (LSG). METHODS: A retrospective analysis of patients with concomitant LRNY or LSG and LVHR from 2013–2015. The association of demographics, comorbidities, hernia characteristics, repair technique, and post-operative weight regain was assessed based on hernia recurrence. RESULTS: We included 90 patients, stratified by hernia recurrence (yes: N = 30, 33.3%, no: N = 60, 66.7%). Median follow-up was equivalent (58.0 months vs. 55.5 months, p = 0.45). The recurrence group had higher rates of cardiovascular disease (CVD) (86.7% vs. 63.3%, p = 0.04), chronic obstructive pulmonary disease (COPD) (13.3% vs. 1.7%, p = 0.04), and prior ventral hernia repair (20.0% vs. 3.3%, p = 0.02) There was no difference in age, pre-operative BMI, defect size, hernia reducibility or use of mesh. Most LVHR (83.3%) recurred before achieving nadir weight. An exploratory decision tree analysis found an age threshold of 45.3 years for hernia recurrence, where frequency increases from 16.1% to 42.4%. Patients > 45.3 years had increased CVD (83.1% vs. 48.4%, p = 0.001) and hypertension (81.4% vs. 48.4%, p = 0.003), but a lower pre-surgery BMI (45.5 vs. 52.1, p = 0.01). CONCLUSION: Hernia recurrence after concomitant BS and LVHR is likely not associated with weight regain, as most patients recur before reaching nadir weight. However, older patients with CVD and prior ventral hernia repairs demonstrated higher recurrence rates and may warrant consideration of staged operations.
Outcomes after ventral mesh removal: a multicentric cohort study.
Turmine J, Joliat GR, Moszkowicz D … +3 more , Belloni E, Romain B, Passot G
Hernia · 2026 Apr · PMID 42047853 · Full text
PURPOSE: In case of infection, recurrence, chronic pain or acute bowel obstruction, removal of a ventral mesh might be necessary. While infrequent, ventral mesh removal can be associated with important postoperative morb...
PURPOSE: In case of infection, recurrence, chronic pain or acute bowel obstruction, removal of a ventral mesh might be necessary. While infrequent, ventral mesh removal can be associated with important postoperative morbidity. The aim of this study was to assess if postoperative major complications occurred more frequently after removal of an intraperitoneal mesh compared to a retromuscular mesh. METHODS: A retrospective cohort study was performed. Patients from 3 centers in France were included. Patients were included if they underwent removal of a ventral mesh for any reason and if older than 18. Patients with intraperitoneal and retromuscular meshes were compared. Overall and major (≥grade 3a) complications were defined according to the Clavien-Dindo classification. The primary endpoint was the rate of major complications. RESULTS: A total of 101 patients were included (50 women, 50%; median age 63, IQR 53–72; median body mass index 29, IQR 27–32; 20 active smokers, 20%; 35 diabetic patients, 35%). Intraperitoneal mesh was present in 74 patients (73%), retromuscular mesh in 22 patients (22%), and subcutaneous mesh in 5 patients (5%). Postoperative complications occurred in 40 patients in the intraperitoneal group (54%) and in 12 patients in the retromuscular group (55%, p = 0.967). Major complication rate was higher in the intraperitoneal group compared to the retromuscular group (18/74 = 24% vs. 1/22 = 5%, p = 0.041). On multivariable analysis, age, smoking, and intraperitoneal mesh removal were found as independent predictors of major complication. CONCLUSION: In this multicentric cohort of patients, removal of intraperitoneal mesh compared to removal of retromuscular mesh was associated with a higher risk of major postoperative morbidity. Use of intraperitoneal mesh for ventral hernia should therefore be cautiously and restrictively considered.
Management of multi-recurrent giant incisional hernia with loss of domain: a multimodal approach using BTA, PPP, and TAR with peritoneal bridging.
Sahoo R, Gupta KP, Ganesh AS … +1 more , Manaswini M
Hernia · 2026 Apr · PMID 42047852 · Publisher ↗
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Do we need another randomised controlled trial for sportsman's groin?
Sheen AJ, McGregor HP
Hernia · 2026 Apr · PMID 42047844 · Publisher ↗
BACKGROUND: Sportsman’s groin, more accurately termed inguinal disruption or inguinal-related groin pain, represents a complex and heterogeneous clinical entity. Despite growing consensus on terminology and advances in i...
BACKGROUND: Sportsman’s groin, more accurately termed inguinal disruption or inguinal-related groin pain, represents a complex and heterogeneous clinical entity. Despite growing consensus on terminology and advances in imaging modalities and rehabilitation strategies, significant uncertainty remains regarding optimal management, particularly in relation to surgical intervention. METHODS: This narrative review evaluates the current literature on the diagnosis, nomenclature, and surgical management of sportsman’s groin. Emphasis is placed on the quality of available evidence, including the predominance of retrospective series and technique-specific reports, as well as the limited number of randomised controlled trials. RESULTS: Surgical treatment is recognised as an appropriate option in selected patients who fail conservative management. However, the evidence base is limited, with only one randomised controlled trial reported to date. Diagnostic challenges persist, particularly in relation to clinical heterogeneity and the limitations of imaging in accurately identifying the underlying pathology. Current studies largely focus on comparisons between open and laparoscopic techniques, with insufficient attention given to the fundamental distinction between mesh-based and suture-based repairs. CONCLUSION: Sportsman’s groin remains a poorly defined and variably managed condition. There is a clear need for improved diagnostic stratification to guide treatment selection. Future research should prioritise high-quality randomised controlled trials, with particular focus on the comparative effectiveness of mesh versus suture repair, rather than solely on surgical approach.
Editorial. Hernia and Sustainability: a paradigm shift toward the future.
Lomanto D
Hernia · 2026 Apr · PMID 42047840 · Publisher ↗
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Self-fixating (sutureless) mesh versus sutured polypropylene mesh in open Lichtenstein repair: a participant-blinded randomized trial.
Tawadrous MRR, Hemeda MS, Aziz AAERAE
Hernia · 2026 Apr · PMID 42045525 · Publisher ↗
BACKGROUND: Open Lichtenstein inguinal hernia repair has been associated with chronic postoperative inguinal pain (CPIP), which remains a problematic outcome. Self-fixating (sutureless) mesh may lessen the tissue trauma...
BACKGROUND: Open Lichtenstein inguinal hernia repair has been associated with chronic postoperative inguinal pain (CPIP), which remains a problematic outcome. Self-fixating (sutureless) mesh may lessen the tissue trauma from fixation sutures and improve postoperative pain-related outcomes. METHODS: Two hundred adult male patients scheduled for elective open Lichtenstein repairs for primary inguinal hernia were enrolled in this single-center parallel-group randomized controlled trial. Participants were randomized to either Group A (self-fixating/sutureless mesh, n = 100) or Group B (sutured polypropylene mesh, n = 100) in a 1:1 ratio. Participants were followed for 6 months. “Pain was measured on postoperative day 1 and at 2 weeks, 2 months, 4 months, and 6 months using a 0–100 visual analog scale (VAS). CPIP was assessed at 4 and 6 months. Secondary outcomes included the SF-36 total score, operative time, length of stay, time to return to work, complications, and mesh-related patient-reported numbness and sensation. Between-group comparisons were conducted at each time point with Holm adjustment for multiple comparisons for each outcome. RESULTS: Group A had lower VAS pain scores than Group B at all time intervals (Holm-adjusted p < 0.001). For example, mean VAS scores were 16.8 ± 4.1 vs 31.5 ± 8.5 on day 1 (mean difference − 14.7; 95% CI − 16.6 to − 12.8), and at 6 months they were 3.8 ± 0.9 vs 12.6 ± 2.8 (mean difference − 8.8; 95% CI − 9.38 to − 8.22). Rescue analgesics during hospitalization were less in Group A (mean difference − 1.40 doses; 95% CI − 1.65 to − 1.15; p < 0.001). Group A had less CPIP at 4 months (2% vs 20%; RR 0.10, 95% CI 0.02 − 0.42; Holm-adjusted p < 0.001) and at 6 months (1% vs 10%; RR 0.10, 95% CI 0.01 − 0.77; Holm-adjusted p = 0.010). SF-36 scores also improved in both groups, but the Holm-adjusted scores did not remain significant. Group A had shorter operative time (mean difference − 11.2 min; 95% CI − 14.1 to − 8.3; p < 0.001), whereas the remaining outcomes, including length of hospital stay, time to return to work, and postoperative complication rates, were similar between the groups. CONCLUSIONS: In adult males who underwent open Lichtenstein repair, self-fixing (sutureless) mesh was associated with lower postoperative pain and a lower incidence of CPIP at 6 months, shorter operative time, and no increase in early complications. These findings warrant additional research, including longer follow-up and multicenter studies.
Time distribution and intraoperative workflow in complex midline incisional hernia repair.
Mitura K, Romanczuk M, Kacprzak L … +7 more , Niecikowski P, Mitura L, Leszczynski PK, Mitura B, Lerchuk O, Khomyak V, Chemerys O
Hernia · 2026 Apr · PMID 42029981 · Publisher ↗
BACKGROUND: Operative time in complex ventral hernia repair is influenced by multiple patient-, hernia-, and procedure-related factors. However, total operative duration provides limited insight into how time is distribu...
BACKGROUND: Operative time in complex ventral hernia repair is influenced by multiple patient-, hernia-, and procedure-related factors. However, total operative duration provides limited insight into how time is distributed across individual steps of the operation and which phases contribute most to variability. METHODS: This observational cohort study included 93 consecutive patients undergoing open complex ventral hernia repair with abdominal wall reconstruction. The operation was divided a priori into seven predefined workflow phases comprising seventeen detailed operative segments. Total operative time and phase-specific durations were recorded prospectively. Time distribution and variability were assessed using descriptive statistics and coefficients of variation. Associations between operative time and patient-, hernia-, and procedure-related factors were analysed using non-parametric tests and multivariable regression. RESULTS: The median total operative time was 167 min (IQR 145–194). Retromuscular dissection with posterior component separation accounted for the largest proportion of operative time. Adhesiolysis and posterior component separation demonstrated the greatest variability, whereas mesh placement, hemostasis, and final closure phases showed low variability. Larger hernia defect area, hernia recurrence, and bilateral transversus abdominis release were significantly associated with longer operative time. In multivariable analysis, defect size, recurrent hernia, and bilateral posterior component separation remained independently associated with prolonged operative duration, while body mass index was not. CONCLUSIONS: Operative time in open complex ventral hernia repair is driven primarily by a limited number of highly variable intraoperative phases rather than uniform prolongation of the entire procedure. Phase-based workflow analysis provides a structured benchmark for operative planning, process optimisation, and future comparisons with emerging surgical technologies.
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