Hernia[JOURNAL]
Sun
200 papers
Fascial closure versus non-closure of laparoscopic port sites: a systematic review and meta-analysis.
Al-Mufargi Y, Al Subhi M, Al-Yousufi M … +3 more , Alomar A, Arba W, Al-Sibani M
Hernia · 2026 Apr · PMID 41996005 · Publisher ↗
BACKGROUND: Fascial closure of laparoscopic port sites remains controversial, particularly regarding its role in preventing port-site hernia and other postoperative complications. This meta-analysis aimed to evaluate the...
BACKGROUND: Fascial closure of laparoscopic port sites remains controversial, particularly regarding its role in preventing port-site hernia and other postoperative complications. This meta-analysis aimed to evaluate the effect of fascial closure on port-site hernia, surgical site infection, bleeding, and operative time. METHODS: A meta-analysis of six studies involving 1,066 patients (463 closure and 603 non-closure) was conducted. Outcomes assessed included port-site hernia, surgical site infection, bleeding, and operative time. Random-effects models were used to calculate pooled risk ratios (RRs), risk differences (RDs), and mean differences (MDs). Prespecified subgroup analyses were performed according to body mass index (BMI), port size, trocar tip type, and study design. Heterogeneity was assessed using the I² statistic. RESULTS: Six studies comprising 1,066 patients were included in the quantitative synthesis. Fascial closure was associated with a significantly lower relative risk of port-site hernia (RR 0.38, 95% CI 0.23–0.63; p < 0.01). However, the pooled absolute risk difference was small and not statistically significant (RD − 0.01, 95% CI − 0.03 to 0.00). No significant differences were observed between closure and non-closure groups for surgical site infection, bleeding, or operative time. CONCLUSION: Fascial closure was associated with a reduced relative risk of port-site hernia, although the absolute benefit was small. No significant differences were observed in infection, bleeding, or operative time. Fascial closure may be considered, particularly for larger ports and higher-risk patients.
Long-term trends and surgical patterns in recurrent groin hernia repair in Japan: insights from the National Clinical Database (2022-2024).
Sato M, Yamamoto H, Poudel S … +8 more , Nagae I, Matsubara T, Tazaki T, Takagi T, Shirabe K, Ueno H, Hachisuka T, Miyazaki K
Hernia · 2026 Apr · PMID 41995980 · Publisher ↗
PURPOSE: Long-term follow-up after groin hernia repair is inherently challenging, and procedure-based registries do not directly capture true recurrence rates. Using the hernia-specific data collection of the National Cl...
PURPOSE: Long-term follow-up after groin hernia repair is inherently challenging, and procedure-based registries do not directly capture true recurrence rates. Using the hernia-specific data collection of the National Clinical Database (NCD), which records detailed information at the time of surgery for recurrence, this study aimed to clarify the timing and hernia types of surgically treated recurrent groin hernias, including very long-term reoperations following childhood repair. METHODS: Recurrence-related analyses were conducted using the hernia-specific data collection of the NCD. The analyses focused on annual surgical volumes of primary and recurrent groin hernia repair, the timing of reoperation and hernia type at reoperation among recurrent cases, and a predefined subanalysis of very long-term reoperations following childhood hernia repair. RESULTS: Recurrent surgeries accounted for 3.6–3.8% of all registered lesions each year (47,753 in 2022; 53,389 in 2023; and 56,140 in 2024). In men, medial inguinal hernias predominated among recurrent lesions, whereas femoral hernias were disproportionately frequent in women. Reoperations most commonly observed within two years but were also observed long after primary repair, including after mesh placement. Among patients with childhood repair, most reoperations occurred after age 60, predominantly for medial inguinal hernias, suggesting adult-type hernia development rather than true postoperative recurrence. CONCLUSION: This large-scale, registry-based analysis delineates characteristic mid- to long-term patterns of surgically treated groin hernia recurrence and provides the first detailed evaluation of timing and hernia type following pediatric repair.
Robotic lateral abdominal hernia repair and outcomes a systematic review and proportional meta-analysis.
Nogueira R, da Silveira CAB, Kasakewitch JPG … +6 more , Lech GE, Lima DL, Martins APD, Cavazzola LT, Malcher F, Sreeramoju P
Hernia · 2026 Apr · PMID 41995970 · Publisher ↗
PURPOSE: Lateral abdominal hernias (LAH) are defined by the presence of a hernia between the linea semilunaris and paraspinal muscles. This type of hernia presents a challenge to repair due to its location and the comple...
PURPOSE: Lateral abdominal hernias (LAH) are defined by the presence of a hernia between the linea semilunaris and paraspinal muscles. This type of hernia presents a challenge to repair due to its location and the complex relationship it has with anatomical structures. Traditionally, they were repaired using an open approach; however, over the last decade, minimally invasive surgery (MIS) techniques have gained popularity, with an increased use of robotic platforms. The robotic platform provides dexterity with articulated instruments and enhanced optics, enabling the performance of complex LAH surgeries using the MIS approach. The robotic approach in LAH repairs demands a special skill from surgeons. Literature is scarce regarding the outcomes related to robotic LAH repairs. We aimed to investigate the outcomes of robotic lateral abdominal hernia (r-LAH) repair in this systematic review., We conducted a literature search on the types of lateral hernia according to the EHS classification, hernia repair techniques, intraoperative complications, and post-operative outcomes. METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. To analyze quality risk-of-bias assessment of all included articles, we applied the Cochrane tools, ROBINS-I, for non-randomized studies. Additionally, we performed a single-arm meta-analysis of post-operative complications, including recurrence, surgical site infection (SSI), seroma, hematoma, and readmission rates. Additionally, we analyzed overall intraoperative complications, conversion rates to open surgery, and length of hospital stay (LOS). Furthermore, a sensitive analysis was conducted to identify possible outlier studies contributing to heterogeneity. Lastly, our proportional meta-analysis was conducted using the metafor package of R software. RESULTS: Our systematic review search yielded 128 articles across five different databases. After removing duplicates and finishing the screening process, the remaining records were thoroughly assessed with their full text, and a total of 4 reports were finally included in this study, comprising 1,374 patients. After analysis was made, we found a cumulative incidence of recurrence of 1.1% (95% CI [0.06; 16.6]; I2 = 67%), a pooled SSI incidence of 3.4% (95% CI [0.77; 14.2]; I2 = 71%), a seroma incidence of 7.6% (95% CI [4.6; 12.4]; I2 = 0%, and a hematoma incidence of 2.5% (95% CI [0.7; 8.5]; I2 = 43%). Also, we found a cumulative readmission rate of 6.3% (95% CI [2.1; 16.9]; I2 = 57%). Furthermore, our analysis showed a mean LOS of 0.88 days (95% CI 0.7; 1.1]; I2 = 63%). All results presenting with high heterogeneity showed a reduction to 0–2% of heterogeneity after sensitivity analysis. CONCLUSIONS: This systematic review and proportional meta-analysis demonstrate that the robotic approach for LAH repairs is a safe MIS technique with minimal morbidity and mortality. However, only a few articles have been published in the current literature regarding robotic Lateral Abdominal Hernia repairs, and more prospective studies are needed in the future to evaluate this approach further. “Level of Evidence: Level III, Systematic Review Study.” STUDY REGISTRATION: A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42023407563)
Diagnostic value of real-time dynamic gastric contrast ultrasound for hiatal hernia.
Jiang Q, Chen L, Ma N … +3 more , Hu M, Zhou T, Liu G
Hernia · 2026 Apr · PMID 41995968 · Full text
PURPOSES: Gastric contrast ultrasound (GCUS) is a real-time, dynamic, noninvasive and radiation-free imaging technique. The diagnostic performance of GCUS in evaluating hiatal hernia (HH) was assessed relative to that of...
PURPOSES: Gastric contrast ultrasound (GCUS) is a real-time, dynamic, noninvasive and radiation-free imaging technique. The diagnostic performance of GCUS in evaluating hiatal hernia (HH) was assessed relative to that of conventional modalities. METHODS: This retrospective study enrolled 177 patients with suspected HH. GCUS was performed at rest and during the Valsalva manoeuvre. The diagnostic performance of GCUS was compared with that of upper gastrointestinal series (UGIS), oesophagogastroduodenoscopy (EGD), contrast-enhanced computed tomography (CECT), and high-resolution manometry (HRM), using surgical or comprehensive clinical diagnosis as the reference standard. RESULTS: GCUS demonstrated a significantly greater diagnostic area under the curve (AUC) for HH than did UGIS, EGD, CECT and HRM (0.974 vs. 0.871, 0.803, 0.822, and 0.672, respectively; all P < 0.05). The sensitivity of GCUS was significantly greater than that of EGD, CECT, and HRM (93.9% vs. 68.6%, 67.8%, and 40.0%, respectively; all P < 0.001). Notably, 52.9% (73/138) of the hernias identified by GCUS were detectable only during the Valsalva manoeuvre. Compared with hernias detectable at rest, these Valsalva-only HHs exhibited smaller hernial sacs (44 vs. 30 mm) and hiatal diameters (26 vs. 20 mm) (both P < 0.001), with significantly greater miss rates for all conventional methods (all P < 0.05). CONCLUSIONS: Real-time dynamic GCUS is a highly accurate, safe and efficient diagnostic tool for detecting HH and is particularly valuable for detecting Valsalva-only HHs, which can be easily missed by conventional methods.
Outcomes of pediatric inguinal hernias at a tertiary hospital in South-Western Uganda.
Mungai E, Oyania F, Sikhondze M … +2 more , Iman H, Atwine D
Hernia · 2026 Apr · PMID 41995956 · Publisher ↗
BACKGROUND: Inguinal hernias, when complicated, can lead to obstruction, strangulation, and death unless early surgical intervention is undertaken. We aimed to determine the clinical presentation, short-term surgical out...
BACKGROUND: Inguinal hernias, when complicated, can lead to obstruction, strangulation, and death unless early surgical intervention is undertaken. We aimed to determine the clinical presentation, short-term surgical outcomes, and their predictors among children undergoing inguinal hernia repair in a low-resource setting. METHODS: A prospective cohort study of 81 children with inguinal hernia and their caretakers was conducted at a tertiary hospital in southwestern Uganda. Questionnaire administration and clinical examination of the children were performed. Postoperative clinical assessments were conducted on days 7, 14, and 30. Surgical outcomes were determined within the 30-day follow-up period. Logistic regression models were fitted to identify factors associated with poor outcomes. RESULTS: Most of the children were male (95.1%), at least 1 year old (86.4%), and had a right-sided inguinal hernia (71.6%) that was indirect (97.5%), reducible (93.8%), and uncomplicated (93.8%). The majority underwent elective surgery (95.1%), and 14.8% had a poor outcome. Prognostic factors included undergoing emergency surgery (p = 0.016), having a sliding or incarcerated hernia, having caregivers aged 18–29 years, and having an irreducible or recurrent hernia. CONCLUSION: Although most children present with uncomplicated inguinal hernias, 1 in 6 still experience poor postoperative outcomes. Predictors include complicated hernias requiring emergency surgery and having a young caregiver. Sensitizing young parents about childhood inguinal hernias could help minimize delayed intervention and reduce poor surgical outcomes.
Chronic groin pain in hernia practice: diagnosis, mechanisms, and management.
Sheen AJ, McGregor HP
Hernia · 2026 Apr · PMID 41995949 · Publisher ↗
BACKGROUND: Chronic groin pain is an increasingly recognised and complex problem in contemporary hernia practice, presenting both as a primary clinical complaint and as a complication following inguinal hernia repair. De...
BACKGROUND: Chronic groin pain is an increasingly recognised and complex problem in contemporary hernia practice, presenting both as a primary clinical complaint and as a complication following inguinal hernia repair. Despite advances in operative techniques and mesh technology, chronic pain remains a leading cause of long-term patient dissatisfaction and reduced quality of life.Aim:To examine the evolving understanding of chronic groin pain, with particular emphasis on chronic postoperative inguinal pain (CPIP), and to explore its implications for hernia surgeons in terms of diagnosis and management. METHODS: A narrative review of the current literature was undertaken, focusing on the pathophysiology, diagnostic challenges, and management strategies associated with chronic groin pain and CPIP. RESULTS: Contemporary evidence indicates that chronic groin pain is multifactorial, arising from a complex interaction of musculoskeletal dysfunction, neuropathic injury, surgical factors, and central sensitisation. CPIP is increasingly recognised as a distinct pain syndrome rather than a simple consequence of technical failure. Diagnostic uncertainty, inconsistent terminology, and overreliance on imaging have contributed to variable outcomes and, in some cases, unnecessary surgical intervention. Conservative management, including structured physiotherapy, mechanism-specific pharmacotherapy, and targeted image-guided injections, forms the cornerstone of treatment. Early multidisciplinary involvement, particularly with pain specialists, enhances diagnostic precision and supports tailored management strategies. CONCLUSION: Chronic groin pain, particularly CPIP, requires a paradigm shift in management away from a purely surgical approach towards a comprehensive, multidisciplinary model. Surgical intervention should be reserved for carefully selected patients with well-defined inguinal-related pain and performed in specialist centres, with the primary goal of pain reduction rather than complete resolution. Future advances will depend on improved diagnostic stratification, validated pain phenotyping, and the development of integrated multidisciplinary care pathways. Chronic groin pain is an increasingly recognised and challenging problem in hernia practice, arising both as a primary presentation and as a complication following inguinal hernia repair. Despite advances in surgical technique and mesh technology, chronic pain remains a major determinant of long-term patient dissatisfaction and impaired quality of life. Contemporary evidence demonstrates that chronic groin pain is rarely attributable to a single anatomical abnormality and instead reflects a complex interplay of musculoskeletal dysfunction, neuropathic injury, surgical factors, and central pain sensitisation. This narrative review examines the implications of this evolving understanding for hernia surgeons, with particular emphasis on chronic postoperative inguinal pain (CPIP). Diagnostic uncertainty, inconsistent terminology, and overreliance on imaging have contributed to unnecessary surgical intervention and variable outcomes. CPIP is now recognised as a distinct pain syndrome rather than a technical failure, requiring a fundamentally different management paradigm. Conservative treatment, including structured physiotherapy, mechanism-specific pharmacotherapy, and targeted image-guided injections, remains the cornerstone of management and should be pursued comprehensively before surgery is considered. Early multidisciplinary involvement, particularly with pain specialists, is essential to improve diagnostic accuracy and guide treatment. Surgical intervention should be reserved for carefully selected patients with clearly defined inguinal-related pain and undertaken only in specialist centres, with the primary aim of pain reduction rather than guaranteed resolution. Future progress will depend less on further technical refinement and more on improved diagnostic stratification, validated pain phenotyping, and integrated multidisciplinary care pathways.
From preoperative to postoperative: gender differences in elective ventral hernia repair.
Head W, Collins CM, Aldridge A … +3 more , Huang LC, Blackman M, Collins CE
Hernia · 2026 Apr · PMID 41995937 · Full text
PURPOSE: Gender represents an important social construct, yet its impact on hernia care is poorly understood. This study aims to evaluate gender-based differences across the continuum of elective ventral hernia managemen...
PURPOSE: Gender represents an important social construct, yet its impact on hernia care is poorly understood. This study aims to evaluate gender-based differences across the continuum of elective ventral hernia management. METHODS: A retrospective cohort study was conducted for adults undergoing elective ventral hernia repair with mesh in the Abdominal Core Health Quality Collaborative registry. Patients were categorized as men or women. Variables analyzed included demographics, comorbidities, hernia characteristics, operative decision-making, postoperative outcomes, and patient-reported outcomes (PROs). Multivariable regression modeling evaluated associations between gender and postoperative outcomes. RESULTS: 27,046 patients were evaluated (53% men, 47% women). Women less often had private insurance (48% vs 56%, p < 0.001) and presented more frequently with larger (width 5 cm vs 4 cm; length 8 cm vs 4 cm, p < 0.001) and recurrent hernias (31% vs 24%, p < 0.001). Operative approach did not differ, yet women more often underwent lengthier repairs (> 2 h 53% vs 40%, p < 0.001) and myofascial release (44% vs 34%, p < 0.001). Women had worse adjusted length of stay (effect 0.219 days, p < 0.001), surgical site infection within 30 days (OR 1.310, p < 0.001), and surgical site infection/occurrence interventions within 30 days (OR 1.144, p = 0.047). They also reported lower quality of life and pain interference at baseline with greater gains across two years (p < 0.001). CONCLUSION: Women presented with more advanced hernia disease requiring more complex reconstruction with worse early morbidity. Despite this, women achieved greater gains in PRO scores relative to men. These findings highlight the need for earlier recognition and targeted optimization to ensure equitable management patterns of ventral hernias.
Incisional hernia repair trends in the last decade (2013-2023): an ACHQC analysis.
Lima DL, Nogueira R, Kasakewitch JPG … +5 more , Morais MC, Sousa AGE, Viana SW, Phillips S, Sreeramoju P
Hernia · 2026 Apr · PMID 41995933 · Publisher ↗
AIM: This study evaluates trends in incisional hernia repair techniques and their associated outcomes over 10 years. It hypothesizes that advancements in surgical techniques have led to an increase in minimally invasive...
AIM: This study evaluates trends in incisional hernia repair techniques and their associated outcomes over 10 years. It hypothesizes that advancements in surgical techniques have led to an increase in minimally invasive procedures, resulting in a subsequent decrease in 30-day postoperative complications. MATERIAL & METHODS: A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) database was conducted from January 2013 to December 2023. Adult patients who underwent incisional ventral hernia repair via open, laparoscopic, or robotic approaches with mesh and 30-day follow-up were included. Data analysis focused on patient demographics, operative details, and postoperative outcomes. RESULTS: 17,078 patients were included after applying the inclusion and exclusion criteria. Over time, a notable shift in surgical techniques was observed. The use of a robotic approach increased from 10% (259) (2013–2015) to 48% (1562) (2022–2023), while open surgeries decreased from 63% (n = 1542) to 46% (n = 1550) in the same period. Median hernia length increased from 10 cm to 11 cm (p < 0.001), while hernia width remained stable (p = 0.5). Both mesh length and width increased significantly (p < 0.001). TAP block use increased from 0% to 20% (p < 0.001). Mesh positioning shifted toward sublay placement (91% to 96%, p < 0.001), particularly retromuscular (43% to 62%, p < 0.001), while intraperitoneal mesh placement declined from 37% to 23% (p < 0.001). Mesh fixation techniques have also changed: use of tackers decreased (35% to 12%, p < 0.001), adhesive use increased (5% to 14%, p < 0.001), and suture use remained stable (p = 0.2). Myofascial release became more frequent (46% to 60%, p < 0.001), along with increased fascial closure (86% to 95%, p < 0.001). Transversus abdominis release increased (59% to 64%, p = 0.01), while external oblique release declined (9% to 2%, p < 0.001). 30-day readmission rates slightly decreased (5% to 4%, p = 0.005), while intraoperative complication rates remained low and stable (2–3%, p = 0.05). CONCLUSION: The findings of this study highlight a significant trend toward minimally invasive surgical techniques in the treatment of incisional hernias over the past 10 years. This shift is accompanied by consistently low early postoperative complications, despite larger hernial defect repairs and the larger mesh.
Incidence, risk factors, and a predictive nomogram for stoma-site incisional hernia after ileostomy reversal: A retrospective study.
Liu X, Shuai J, Wang D … +1 more , Chen S
Hernia · 2026 Apr · PMID 41995917 · Publisher ↗
PURPOSE: The incidence of stoma-site incisional hernia (SSIH) in rectal cancer patients varies widely in the literature. This study aimed to determine the incidence of SSIH, identify its risk factors, investigate the imp...
PURPOSE: The incidence of stoma-site incisional hernia (SSIH) in rectal cancer patients varies widely in the literature. This study aimed to determine the incidence of SSIH, identify its risk factors, investigate the impact of adjuvant therapy, and subsequently develop a predictive model. METHODS: This was a single-centre, retrospective study involving consecutive patients who underwent radical resection for rectal carcinoma with temporary diverting loop ileostomy and subsequent stoma reversal at our centre from 2020 to 2024. Patient demographic characteristics, comorbidities, operative data, and follow-up information were collected. Logistic univariate and multivariate analyses were used to identify the risk factors for SSIH, following which we constructed a nomogram for SSIH prediction. RESULTS: 331 patients were enrolled in the study, the incidence of stoma site incisional hernia was 24.8% (82/331). Multivariate analysis identified advanced age (≥ 65 years), body mass index (BMI) ≥ 24 kg/m, stoma diameter ≥ 3 cm, delayed stoma reversal (≥ 6 months), presence of a parastomal hernia, and postoperative surgical site infection (SSI) and a low postoperative-to-preoperative albumin ratio(< 0.85) as independent risk factors. Neither adjuvant chemotherapy, radiotherapy, nor immunotherapy was identified as an independent risk factor for SSIH in the multivariate logistic regression analysis. CONCLUSION: A nomogram based on perioperative patient factors was constructed to predict the occurrence of stoma site incisional hernia (SSIH) after ileostomy reversal in rectal cancer patients. The nomogram demonstrated strong predictive performance and good calibration, providing clinicians with a valuable tool to identify high-risk patients and implement targeted preventive strategies.
Intraperitoneal Onlay mesh - non-closure (IPOM) vs. fascial closure (IPOM-Plus) vs. peritoneal bridging (IPOM-Pb) in laparoscopic ventral hernia repair: a randomized controlled trial.
Kumar J, Sinha T, Kumar S … +2 more , Kumar RR, Iftikhar S
Hernia · 2026 Apr · PMID 41995907 · Publisher ↗
PURPOSE: Intraperitoneal onlay mesh (IPOM) repair without defect closure and IPOM with primary fascial closure (IPOM-Plus) are established techniques for laparoscopic ventral hernia repair. In contrast, evidence for IPOM...
PURPOSE: Intraperitoneal onlay mesh (IPOM) repair without defect closure and IPOM with primary fascial closure (IPOM-Plus) are established techniques for laparoscopic ventral hernia repair. In contrast, evidence for IPOM with peritoneal bridging is limited and mainly comes from single-group studies. This randomized controlled trial compared these three methods regarding early postoperative outcomes in moderate midline ventral hernias. METHODS: This study was a single-center, prospective, randomized trial involving 120 adult patients with midline ventral hernias, with horizontal defect widths ranging from 3 to 6 cm (4.6 ± 1.2 cm). Participants were evenly divided into IPOM, IPOM-Plus, or IPOM-Pb groups. A single surgeon performed all procedures, using the same mesh, fixation, and perioperative protocols. Primary outcomes were postoperative seroma formation, pain scores at 48 h and on postoperative days 5 and 10, and short-term recurrence at six months. Secondary outcomes included operative time, conversion to open surgery, and length of hospital stay. RESULTS: Early postoperative seroma was significantly more frequent in the IPOM-Pb group at 48 h and postoperative day 5 compared with IPOM-Plus (12.5% vs. 2.5%; risk difference 10%, 95% CI 0.1–19.9; p = 0.025). Pain scores at all assessed time points were similar across groups. One hernia recurrence occurred in the IPOM group at six months. Operative time was significantly longer for IPOM-Pb compared with IPOM and IPOM-Plus (p < 0.001). Conversion rates and hospital stay length did not show significant differences. CONCLUSIONS: IPOM-Pb had higher early seroma rates and longer operative times without clear short-term benefits, supporting IPOM Plus as a balanced and reliable standard technique for laparoscopic repair of moderate midline ventral hernias. TRIAL REGISTRATION: CTRI No. CTRI/2023/08/056745
Comment to: Parainguinal or Spigelian hernia: a clinically important distinction.
Pélissier E, Cossa JP, Ngo P … +1 more , Valenti A
Hernia · 2026 Apr · PMID 41995899 · Publisher ↗
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The impact of socioeconomic status in hernia treatment: a qualitative systematic review.
Lyons G, Viana SW, Neves VDS … +6 more , Wilmsen CD, Nogueira R, Cavazzola LT, Augenstein V, Malcher F, Lima DL
Hernia · 2026 Apr · PMID 41995894 · Publisher ↗
INTRODUCTION: Hernias are among the most common surgical conditions worldwide. However, access to optimal treatment remains disproportionately distributed. Socioeconomic disparities play a critical role in determining wh...
INTRODUCTION: Hernias are among the most common surgical conditions worldwide. However, access to optimal treatment remains disproportionately distributed. Socioeconomic disparities play a critical role in determining whether patients receive timely surgical intervention, access to minimally invasive techniques, or suffer from postoperative complications due to delayed or suboptimal care. This study aims to evaluate the impact of socioeconomic disparities on the treatment of ventral hernia repair. METHODS: This systematic review was conducted following PRISMA guidelines. A comprehensive search was conducted using MEDLINE/Pubmed, EMBASE, Web of Science, Cochrane Library, and LILACS, from inception until March 2026 without any filter applied. A search strategy was created using the MeSH terms. Our inclusion criteria comprise studies related to socioeconomic disparities in ventral hernia repair within the United States. Due to heterogeneity in study designs, socioeconomic variables, and outcome definitions, a meta-analysis was not feasible, and findings were synthesized using a narrative synthesis. A qualitative assessment of included studies was made using the Cochrane Risk of Bias tool, ROBINS-I. RESULTS: A total of 28 studies were included, encompassing 2,096,513 patients with ventral hernia. Most were retrospective cohorts, with sample sizes ranging from a few hundred to over 665,000 patients. Across studies, patients with government funded insurance (Medicaid or Medicare) generally experienced higher rates of complications, readmissions, and recurrences compared to commercial insured patients, although the magnitude of association varied. Odds ratios demonstrated increased risks of wound complications, readmission, and recurrence among government funded insured and uninsured patients, while commercial insured and higher-income patients were more likely to undergo advanced surgical approaches and had shorter hospital length of stay. Some studies also highlighted socioeconomic and racial disparities, with vulnerable populations and minority groups showing disproportionately higher complication rates and different patterns of insurance coverage. CONCLUSION: This systematic study demonstrates significant racial and socioeconomic disparities in ventral hernia repair. Government funded insurance holders or lower incomers, faced higher complication rates, more emergent presentations, and worse outcomes, including increased mortality and readmissions. Moreover, they usually have less access to minimally invasive and robotic techniques. These inequities highlight systemic barriers in healthcare access.
Retrospective analysis of open preperitoneal hernioplasty in emergency settings: clinical outcomes and challenges.
D'Ambrosio GM, Blanc IL, Barceló AP … +6 more , Cabré LC, Solerdelcoll MS, González RP, Caviedes RM, Duarte AM, López JAG
Hernia · 2026 Apr · PMID 41995889 · Publisher ↗
PURPOSE: To evaluate the surgical and postoperative outcomes of open preperitoneal hernioplasty in emergency surgery for inguino-crural hernias, focusing on morbidity, complication rates, and the feasibility of the techn...
PURPOSE: To evaluate the surgical and postoperative outcomes of open preperitoneal hernioplasty in emergency surgery for inguino-crural hernias, focusing on morbidity, complication rates, and the feasibility of the technique in elderly patients and surgeons not specialized in abdominal wall surgery. The aim is to provide evidence on the safety, efficacy, and applicability of this approach. METHODS: Retrospective, observational, single-center study (2018–2023) including patients undergoing emergency open preperitoneal hernioplasty. Clinical, demographic, and surgical data were obtained from medical records and analyzed using descriptive and multivariate statistics with SPSS. RESULTS: A total of 122 patients were analyzed (median age: 64 years; 53.3% over 80 years). Comorbidities were present in 86.9% of patients, most commonly cardiovascular. The most frequent hernia types were lateral (39.3%), followed by medial (36.1%) and femoral (24.6%). Intestinal obstruction was present in 37.7% at admission. Polypropylene mesh was used in all cases, primarily fixed with glue (86%). Only one conversion to laparotomy occurred. 73% of patients had no complications; 22.1% experienced minor complications (Clavien-Dindo I/II) and 4.9% major complications (III/IV). No significant differences were found between specialized and non-specialized surgeons. Recurrence rates were 0% at 6 months and 2.5% at 12 months, with follow-up losses of 22.1% and 35.2%, respectively. CONCLUSION: Open preperitoneal hernioplasty is a safe, effective, and reproducible technique in emergency surgery. Its low complication profile, absence of conversion to midline laparotomy, and accessibility make it a viable option even for non-specialized surgeons. Its use should be encouraged and further compared with other surgical approaches.
Non operative management of postpartum Diastasis Recti: a systematic review and metanalysis of randomized controlled trials.
Capoccia Giovannini S, Hoffmann H, Bracale U … +4 more , Cavallaro G, Iacone BM, Camerini G, Stabilini C
Hernia · 2026 Apr · PMID 41995887 · Full text
PURPOSE: Rectus Abdominis Diastasis (RAD) is a prevalent postpartum condition, yet consensus regarding the efficacy of conservative management remains limited. This meta-analysis evaluates the effectiveness of structured...
PURPOSE: Rectus Abdominis Diastasis (RAD) is a prevalent postpartum condition, yet consensus regarding the efficacy of conservative management remains limited. This meta-analysis evaluates the effectiveness of structured exercise programs in reducing Inter-Recti Distance (IRD) and improving functional outcomes in postpartum women compared to no-treatment or standard care. METHODS: A systematic search was conducted for Randomized Controlled Trials (RCTs) published before August 2025. The primary outcome was IRD reduction; the secondary outcome was physical disability assessed via the Oswestry Disability Index (ODI). Methodological quality and certainty of evidence were evaluated using Revised Cochrane Risk-of-Bias (RoB 2) and GRADE criteria. RESULTS: Nine RCTs (450 participants) were included for IRD analysis, demonstrating a significant reduction in the exercise group (MD: -8.05 mm; 95% CI: -10.43, -5.68; p < 0.05). Subgroup analyses showed that interventions initiated < 3 months postpartum achieved greater reduction (MD: -10.2 mm; 95% CI: -14.94, -5.46) than delayed starts. Crucially, while no significant difference was found between specific types of training (p = 0.32), a consistent advantage was observed for structured exercise over no intervention or standard care. Regarding functional outcomes, meta-analysis of 3 comparisons from 2 RCTs (n = 115) using the ODI score showed no significant difference between groups (MD: 0.82 higher score; 95% CI: -2.75, 4.38; p = 0.75; I20%). CONCLUSIONS: Structured exercise programs significantly reduce IRD in women with RAD. However, this anatomical improvement does not translate into superior functional recovery, as measured by the ODI score, within the observed periods. Further standardized research is warranted to establish optimal clinical protocols and the need for RAD-specific functional scales in future research.
PVDF versus polypropylene large pore mesh for open incisional hernia repair - a case control matched analysis.
Van Der Velde G, Gros T, Allaeys M … +2 more , Dries P, Berrevoet F
Hernia · 2026 Apr · PMID 41995883 · Publisher ↗
PURPOSE: Several types of compound plastics are used in the fabrication of surgical mesh, influencing the specific tissue response to mesh fibers and thus the suitability of the mesh. Experimental data suggests that poly...
PURPOSE: Several types of compound plastics are used in the fabrication of surgical mesh, influencing the specific tissue response to mesh fibers and thus the suitability of the mesh. Experimental data suggests that polyvinylidene fluoride (PVDF) seems more resistant to hydrolysis and degradation compared to polyethylene-terephthalate (PET) or polypropylene (PP) and there might be an improved biocompatibility compared to PP, while ageing does not increase stiffness. Although PVDF has been introduced in abdominal wall repair since years, the clinical data for its use in retromuscular ventral and incisional hernia repair are scarce, as are data on outcome after longterm follow-up. METHODS: Patients having an open, elective incisional hernia repair at our tertiary academic center from 2014 to 2021, with retromuscular implantation of a large-pore PP mesh (n = 108, PP-group) and 109 patients using a large-pore PVDF mesh (PVDF-group) were matched based on BMI, number of comorbidities, number of risk factors and hernia width resulting in a total of 98 matched patients. Four years follow-up and complications from Clavien-Dindo class IIIa on were collected according to the EHS guidelines. (Trial number: B670201734087) RESULTS: In the matched cohort, 77.6% of patients in the PVDF-group and 79.6% in the PP-group had no grade IIIa to IVb complications during the total follow-up time (p = 0.806). 16.3% of the patients in both the PVDF-group and the PP-group had a SSO. Only 2% in the PP-group versus 4.1% of the patients in the PVDF-group had a SSI (p = 1.00). The most observed complication was seroma with an overall prevalence in 8.2% of patients in both the PVDF-group and PP-group. After 4 years of follow-up only 1 patient with PVDF-mesh had a hernia recurrence requiring surgical intervention, appearing within one month after hospital discharge. CONCLUSION: PVDF meshes show both long-term safety and efficacy. Considering recurrence rate and complications requiring surgical interventions, large pore PVDF-meshes as well as PP-meshes show excellent results. Mostly, hernia size and extensive surgical dissection seem to influence complication rate. Future research should focus more on patient reported outcomes, quality of life and pain scores by large multi-center trials or registry data.
Laparoscopy-assisted versus open surgery for reconstruction of abdominal wall defects following endometriosis resection: a retrospective cohort study.
Ding D, Wang Y, Wang H … +4 more , Liang R, You J, Ye Q, Wei B
Hernia · 2026 Apr · PMID 41995792 · Full text
BACKGROUND: The optimal surgical approach for reconstructing abdominal wall defects after radical resection of abdominal wall endometriosis (AWE) remains debated. This study aimed to compare the perioperative safety, rec...
BACKGROUND: The optimal surgical approach for reconstructing abdominal wall defects after radical resection of abdominal wall endometriosis (AWE) remains debated. This study aimed to compare the perioperative safety, recovery outcomes, and short-term efficacy of laparoscopy-assisted versus open repair for AWE surgery. METHODS: In this single-center retrospective cohort study, 32 patients who underwent radical AWE resection and abdominal wall reconstruction between July 2023 and June 2025 were included. Patients were divided into two groups: open surgery (n = 18) and laparoscopy-assisted surgery (n = 14). Operative parameters, postoperative recovery, inflammatory markers, pain scores, and complications were compared between the two groups. RESULTS: The two groups were well balanced in baseline characteristics. The laparoscopy-assisted group had a significantly shorter incision length (6.46 ± 0.89 vs. 10.17 ± 1.60 cm, P < 0.001), fewer drainage tubes (0.79 ± 0.43 vs. 2.56 ± 0.51, P < 0.001), shorter drainage duration (2.79 ± 1.85 vs. 4.78 ± 2.60 days, P = 0.017), and shorter hospital stay (5.86 ± 1.83 vs. 7.61 ± 2.40 days, P = 0.026). Consistently, pain scores on postoperative days 3 and 5 were significantly lower in the laparoscopy-assisted group (P < 0.001). Notably, there was no significant differences in total operative time (P = 0.411), intraoperative blood loss (P = 0.453), postoperative specimen diameter (P = 0.876), time to first flatus (P = 0.320), time to first diet (P = 0.533), time to first ambulation (P = 0.443), and total complications (P = 1.000) between the two groups. No significant intergroup differences were found in incisional numbness or chronic pain at 6 months. Additionally, neither group exhibited abdominal hernia or recurrence of AWE. CONCLUSION: In conclusion, the laparoscopy-assisted approach offers a minimally invasive alternative that enhances early postoperative recovery—evidenced by shorter incisions, fewer drains, and less pain—while maintaining comparable operative times, safety profiles, and AWE radical treatment to the conventional technique.
What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? An updated systematic review and meta-analysis of randomized clinical trials and trial sequential analysis.
Lyons G, Nogueira R, Viana SW … +5 more , Andrade MF, Neves V, Galhego RF, Pascotini N, Lima DL
Hernia · 2026 Apr · PMID 41995773 · Publisher ↗
INTRODUCTION: This systematic review and meta-analysis seeks to evaluate the effectiveness of abdominal and pelvic floor muscle (PFM) exercise programs in the treatment of postpartum diastasis recti abdominis (DRA). Spec...
INTRODUCTION: This systematic review and meta-analysis seeks to evaluate the effectiveness of abdominal and pelvic floor muscle (PFM) exercise programs in the treatment of postpartum diastasis recti abdominis (DRA). Specifically, we aim to update the current evidence by reassessing the impact of exercise-based interventions on inter-recti distance (IRD). METHODS: A comprehensive online search was conducted using MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, and LILACS, from inception until January 2025 without any filter applied. Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. To maintain rigor and mitigate bias in the analysis and results, a search for studies was conducted using the same search strategy employed in the previous study. The primary outcome was change in IRD or presence of DRA. Study quality was assessed using the Rob 2 approach. Meta-analyses were performed using R software (version 4.4.2), with pooled effects expressed as mean differences (MD) and 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I2 statistic. RESULTS: A total of 93 records were screened, of which 11 studies met the inclusion criteria. Four additional studies were retrieved from the prior systematic review, yielding a total of 15 studies and 803 participants. Among these, three studies provided sufficient homogeneity to be included in the meta-analysis. The pooled analysis demonstrated no statistically significant difference in IRD between participants undergoing transversus abdominis (TrA) focused exercise and those receiving minimal or no intervention (MD -0.06 cm; 95% CI -1.19 to 1.08; p = 0.92). Considerable heterogeneity was observed, likely reflecting differences in intervention protocols, participant characteristics, and outcome assessment methods. CONCLUSION: This updated systematic review and meta-analysis found no evidence to support the effectiveness of exercise-based interventions as a standalone treatment for reducing IRD in postpartum women. Although exercise may provide functional or symptomatic benefits, its impact on anatomical correction appears limited. These findings highlight the need for well-designed randomized controlled trials and suggest that, in selected cases, alternative or adjunctive therapeutic strategies, including surgical approaches, may be required to achieve meaningful anatomical restoration. STUDY REGISTRATION: This systematic review was registered in the PROSPERO database CRD420251276159.
Measuring symptoms in parastomal hernia: a prospective evaluation using MYMOP2.
Warner-Levy A, Vijayan D, Lockett K … +2 more , Goscimski A, Slade D
Hernia · 2026 Apr · PMID 41995772 · Publisher ↗
BACKGROUND: Parastomal hernia (PSH) is a common complication following stoma formation, associated with pain, and impaired quality of life (QoL). Despite this, no validated disease-specific patient-reported outcome measu...
BACKGROUND: Parastomal hernia (PSH) is a common complication following stoma formation, associated with pain, and impaired quality of life (QoL). Despite this, no validated disease-specific patient-reported outcome measure (PROM) exists for PSH. Non-operative interventions on symptom burden have not been well quantified. The Measure Yourself Medical Outcome Profile (MYMOP2), a patient-generated tool, may capture PSH-specific symptoms and their change over time. OBJECTIVE: To evaluate changes in patient-reported symptom burden, using MYMOP2, following surgical or conservative management in a dedicated specialist PSH clinic. METHODS: A single-centre prospective cohort study included consecutive patients attending a monthly multidisciplinary PSH-only clinic between May 2022 and October 2025. From February 2023, all new patients completed MYMOP2 at baseline and at follow-up (≥ 2 months post-intervention). Demographic and clinical data were obtained from clinical records. The primary outcome was change in MYMOP2 Profile score. Secondary outcomes were changes in domain-specific scores (Symptom 1, Symptom 2, Overall Symptom Score, Activity and Wellbeing) and comparisons between conservative and surgical management. RESULTS: Of 137 patients, 36 completed baseline and follow-up MYMOP2 data (14 conservative, 22 surgical). Baseline MYMOP2 Profile scores were similar (median 16 for both groups). Surgical repair produced significant improvements in MYMOP2 Profile (16 to 5.5, p < 0.0001), Overall Symptom (8.5 to 2, p < 0.0001), Wellbeing (4 to 1.5, p = 0.0015) and Activity scores (4.5 to 2, p < 0.001). Conservative management also resulted in improvements in Profile (16 to 7, p < 0.001), Overall Symptom Score (8 to 3, p = 0.002) and Activity (5 to 1.5, p = 0.005). CONCLUSION: A dedicated multidisciplinary PSH clinic achieves meaningful reductions in patient-reported symptom burden following conservative and surgical management. Although surgery yields greater improvement, non-operative interventions also provide benefit. MYMOP2 is a pragmatic outcome measure for PSH and merits further validation in larger cohorts.
Laparoscopic iliopubic tract repair for adolescent inguinal hernia: a large-scale cohort study of 433 cases demonstrating a safe, mesh-free technique.
Lee SR
Hernia · 2026 Apr · PMID 41995763 · Publisher ↗
PURPOSE: The optimal surgical strategy for adolescent inguinal hernia remains controversial because this population lies between pediatric and adult hernia pathology. Pediatric high ligation may be insufficient in adoles...
PURPOSE: The optimal surgical strategy for adolescent inguinal hernia remains controversial because this population lies between pediatric and adult hernia pathology. Pediatric high ligation may be insufficient in adolescents with posterior wall weakness, while routine mesh repair raises concerns regarding chronic pain and long-term foreign-body complications. Laparoscopic iliopubic tract repair (IPTR) offers a mesh-free posterior wall reinforcement strategy specifically suited to adolescent anatomy. METHODS: This retrospective cohort study included 433 adolescents aged 10–19 years who underwent laparoscopic IPTR for indirect inguinal hernia between January 2014 and December 2023. Operative outcomes, postoperative complications, chronic inguinodynia, and recurrence rates were analyzed. RESULTS: The mean age at surgery was 13.2 ± 2.9 years, and 75.3% of patients were male. Most hernias were unilateral (97.2%), with inguinal hernias at 86.8% and inguinoscrotal hernias at 13.2%. All procedures were completed laparoscopically without conversion. The mean operative time was 16.8 ± 2.9 min for unilateral repair and 28.8 ± 5.8 min for bilateral repair. Postoperative complications were rare (0.7%), including hematoma and seroma. During a mean follow-up of 67.6 ± 34.0 months, four patients (0.9%) required reoperation for chronic pain, metachronous contralateral hernia, or recurrence. Hernia recurrence occurred in two patients (0.5%), both within the first postoperative year; all recurrences were successfully managed laparoscopically. CONCLUSIONS: Laparoscopic IPTR is a safe, durable mesh-free technique for adolescent inguinal hernia repair, with low morbidity and excellent long-term recurrence rates. This approach may serve as a reliable surgical bridge between pediatric high ligation and adult mesh repair in adolescents.
Differences in Long-term Quality of Life Assessed by the EuraHS-QoL Scale between Laparoscopic Transabdominal Preperitoneal Repair and Lichtenstein Tension-Free Repair for Primary Unilateral Inguinal Hernia.
Xu H, Zou W, Zheng K … +1 more , Li B
Hernia · 2026 Apr · PMID 41995761 · Publisher ↗
OBJECTIVE: To evaluate the differences in quality of life at 5 years postoperatively between laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein tension-free repair for adult patients with primary un...
OBJECTIVE: To evaluate the differences in quality of life at 5 years postoperatively between laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein tension-free repair for adult patients with primary unilateral inguinal hernia, with a primary focus on EuraHS-QoL scale scores and an exploration of long-term outcomes including chronic postoperative pain, recurrence rates, functional recovery, and patient satisfaction. METHODS: This was a single-center retrospective cohort analysis. Adult patients who underwent TAPP or Lichtenstein repair for primary unilateral inguinal hernia between January 2015 and December 2020 were included. Patients were categorized into a TAPP group (n = 300) and a Lichtenstein group (n = 200) based on the surgical approach. The primary outcome was the quality of life score at 5 years postoperatively, assessed using the EuraHS-QoL scale across three domains: pain, activity restriction, and cosmetic appearance. Secondary outcomes included the incidence of chronic postoperative pain, hernia recurrence rate, postoperative complications, time to functional recovery (e.g., return to daily activities and work), and subjective satisfaction. Multivariate regression models were used to control for confounding factors, and sensitivity analysis was performed using propensity score matching (PSM). RESULTS: The median follow-up duration was 62 months (IQR: 60-66). The TAPP group demonstrated a significantly better total EuraHS-QoL score [median 2.0 (IQR: 1.0-4.0)] compared to the Lichtenstein group [median 3.0 (IQR: 2.0-5.0)] (P < 0.001), with particularly pronounced differences in the activity restriction and cosmetic appearance domains (P < 0.01). The TAPP group had a lower incidence of chronic postoperative pain (12.0% vs. 20.5%, P = 0.006), faster functional recovery (time to return to daily activities: 6 days vs. 8 days, P < 0.001), and higher satisfaction scores (8.8 ± 1.1 vs. 7.9 ± 1.4, P < 0.001). No statistically significant differences were observed between the two groups in recurrence rates or overall complication rates. The findings remained consistent after multivariate regression and PSM analysis. CONCLUSION: In this retrospective analysis, both TAPP and Lichtenstein repair provided favorable long-term quality of life. While initial unadjusted comparisons suggested a total score advantage for TAPP, this was not maintained in the matched sensitivity analysis. TAPP demonstrated benefits in reduced chronic pain and faster functional recovery, without increasing recurrence. These findings support the consideration of TAPP as a viable option in suitable patients, though they should be interpreted in light of the study's retrospective design and require prospective validation.
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