Hernia[JOURNAL]
Sun
200 papers
A traction suture for abdominal wall closure in large incisional hernias: a prospective analysis of the "suitcase technique" - a simple horizontal offloading z-suture for gradual myofascial approximation.
Mitura K, Romanczuk M, Kacprzak L … +7 more , Kisielewski K, Mitura L, Niecikowski P, Leszczynski PK, Lerchuk O, Chemerys O, Khomyak V
Hernia · 2026 Apr · PMID 41995872 · Publisher ↗
PURPOSE: Primary myofascial closure in large incisional hernia repair remains technically challenging due to excessive tension, loss of domain, and limited accessibility of costly traction devices. This study aimed to ev...
PURPOSE: Primary myofascial closure in large incisional hernia repair remains technically challenging due to excessive tension, loss of domain, and limited accessibility of costly traction devices. This study aimed to evaluate the feasibility, biomechanical effect, and short-term outcomes of a novel horizontal traction suture method—the suitcase technique—designed to facilitate gradual fascial approximation. METHODS: This prospective, single-center study included 69 patients undergoing elective open repair of large midline incisional hernias (defect width 8–20 cm) with retromuscular mesh placement. Patients were stratified into two groups based on defect width (≤ 14 cm and 14–20 cm). The ‘suitcase technique’, consisting of a centrally placed Z-suture (‘suitcase’ suture), was applied prior to definitive fascial closure. Tensile force required for fascial approximation and resting distance between fascial edges were measured before Z-suture placement and after 5 and 10 min. Primary outcome was successful primary myofascial closure. Secondary outcomes included operative parameters and postoperative complications. RESULTS: Successful primary myofascial closure was achieved in all patients with defects ≤ 14 cm and in 76.7% of patients with defects > 14 cm. Application of the ‘suitcase’ suture resulted in a progressive reduction in tensile force required for fascial approximation. After 10 min the tensile force decreased respectively by 8.2 N (34.3%) in Group 1 and 8.1 N (27.7%) in Group 2 (p = 0.001). After 10 min of sustained ‘suitcase’ suture application, the resting fascial edge distance was reduced by 4.6 cm (43.8%) in Group 1 and by 4.6 cm (28.8%) in Group 2 (p = 0.019).Transversus abdominis release was performed in 75.4% of patients to ensure adequate mesh overlap. No reoperations were required. Postoperative complications were infrequent and manageable, with no early hernia recurrences observed at 12-month follow-up. CONCLUSION: The suitcase technique is a simple, cost-effective, and reproducible method that facilitates gradual myofascial approximation and enables primary fascial closure using the small bites technique with low morbidity. It represents a valuable alternative to dedicated intraoperative traction devices, particularly in resource-limited settings.
Early prediction of bowel necrosis in incarcerated groin hernia using parsimonious machine learning models: a retrospective cohort study.
Xia Y, Wang M
Hernia · 2026 Apr · PMID 41984331 · Publisher ↗
BACKGROUND: Early identification of bowel necrosis in patients with incarcerated groin hernia (IGH) remains clinically challenging, yet is crucial for timely surgical decision-making and improved outcomes. Reliable early...
BACKGROUND: Early identification of bowel necrosis in patients with incarcerated groin hernia (IGH) remains clinically challenging, yet is crucial for timely surgical decision-making and improved outcomes. Reliable early risk stratification tools are currently lacking. METHODS: We conducted a retrospective cohort study of patients surgically treated for IGH between January 2014 and December 2025. Using routinely available admission data, a rigorous three-stage feature selection strategy was applied within the training cohort to identify core predictors. Seven machine learning models were developed and internally validated using ten-fold cross-validation with random over-sampling. Model performance was evaluated using discrimination, calibration, and decision curve analyses. Model interpretability was assessed using SHapley Additive exPlanations (SHAP), and a nomogram was constructed based on logistic regression. RESULTS: A total of 220 patients were included, of whom 79 (35.9%) developed bowel necrosis requiring resection. Five core predictors were consistently identified: bowel obstruction, time from onset to admission, VAS score, white blood cell count, and serum sodium level. Among all models, the gradient boosting machine achieved the highest discriminative performance in the test cohort (AUROC = 0.919; AUPRC = 0.818), while the logistic regression model demonstrated excellent calibration and clinical interpretability. SHAP analysis confirmed the relative importance and directional effects of the selected predictors. CONCLUSIONS: This study presents a parsimonious and interpretable machine learning framework for early prediction of bowel necrosis in IGH. The proposed models may support timely surgical decision-making and improve risk stratification in emergency surgical practice.
Minimally invasive versus open repair in inguinal hernia: A contemporary systematic review and network meta-analysis of 23 randomized trials (1995-2025).
Banerjee DJ, Sen PP
Hernia · 2026 Apr · PMID 41984280 · Publisher ↗
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Efficacy and safety of mesh reinforced cruroplasty with Phasix™ ST vs. Bio-A: systematic review and bayesian meta-analysis.
Manara M, Bona D, De Bernardi S … +8 more , Cavalli M, Wang Q, Bonitta G, Guido D, Biondi A, Campanelli G, Bonavina L, Aiolfi A
Hernia · 2026 Apr · PMID 41984260 · Full text
PURPOSE: Recurrence remains a major challenge after minimally invasive hiatus hernia (HH) repair, particularly in patients with large diaphragmatic defects. Currently, biosynthetic absorbable meshes such as Bio-A® and Ph...
PURPOSE: Recurrence remains a major challenge after minimally invasive hiatus hernia (HH) repair, particularly in patients with large diaphragmatic defects. Currently, biosynthetic absorbable meshes such as Bio-A® and Phasix™ ST are widely used to reinforce cruroplasty, however evidence comparing their efficacy and safety profile remains limited. This study aims to compare the safety and efficacy of Bio-A® versus Phasix™ ST after minimally invasive HH repair through a Bayesian meta-analysis. METHODS: Systematic search across online databases up to November 2025 was performed. Inclusion criteria targeted elective minimally invasive HH repairs with Bio-A® or Phasix™ ST mesh. Primary outcome was radiologically or endoscopically confirmed anatomical HH recurrence. Overall, severe (Clavien-Dindo ≥ 3), mesh-related complications and reoperation for recurrence were secondary outcomes. A Bayesian hierarchical power prior model was utilised to pool data from both comparative and single-arm studies. RESULTS: Twenty-one observational studies (2208 patients) were included. Bio-A® was used in 53.1% of cases. The overall recurrence rate was 8.2% (n = 170 patients), with a clinical trend toward higher recurrence for Bio-A® vs. Phasix™ ST mesh (10% vs. 6%). The Bayesian meta-analysis showed no statistically significant difference for Bio-A® vs. Phasix™ ST (RR = 1.29, 95% HPD 0.01–8.15). Notably, 38 over 170 patients (17%) required reoperation for HH recurrence with a trend toward higher rates for Bio-A® vs. PhasixTM (36.3% vs. 19.3%). Overall (RR = 1.16, 95% HPD 0.01–8.75) and severe postoperative complications (RR = 1.06, 95% HPD 0.01–12.33) were comparable. Mesh-related complication with esophageal fibrosis occurred in one Bio-A® patient (0.04%). CONCLUSION: Bio-A® and Phasix™ ST synthetic absorbable meshes seem safe and effective for hiatal reinforcement with apparently similar rates of recurrence and postoperative morbidity. The choice between these materials should be guided by surgeon preferences and cost-effectiveness.
Open versus robotic-assisted repair of midline ventral hernias with defect width 2-8 cm - a randomized clinical trial (OVER).
Nielsen KA, Valorenzos A, Tsigka E … +5 more , Frandsen CH, Helligsø P, Petersen SR, Ellebaek MB, Nielsen MF
Hernia · 2026 Apr · PMID 41925930 · Full text
PURPOSE: To compare short-term clinical outcomes, inflammatory response, and patient-reported quality of life after open versus robotic-assisted ventral hernia repair (oVHR vs. rVHR). METHODS: This randomized controlled...
PURPOSE: To compare short-term clinical outcomes, inflammatory response, and patient-reported quality of life after open versus robotic-assisted ventral hernia repair (oVHR vs. rVHR). METHODS: This randomized controlled trial included adults with midline ventral hernias (2–8 cm). Patients were randomized to oVHR or rVHR. The primary endpoint was postoperative length of stay (LOS). Secondary outcomes included operative time, complications, quality of life, and inflammatory response measured by CRP. The primary outcome was analyzed using Poisson regression adjusted for defect size, repeated measures with linear mixed-effects models, and binary outcomes with logistic regression. RESULTS: Fifty-six patients were analyzed (rVHR = 29, oVHR = 27). Median operative time was longer for rVHR (129 min) than oVHR (80 min, p < 0.001). Mean LOS was significantly shorter after rVHR (0.46 days, 95 % CI 0.21–0.72) than oVHR (1.96 days, 95 % CI 1.43–2.49, p < 0.001). The benefit increased with defect size, corresponding to a predicted one-day difference at 17 cm². Postoperative CRP levels were lower after rVHR on both day 1 (23 vs 46 mg/L, p < 0.001) and day 3 (33 vs 70 mg/L, p < 0.001). Complication rates were similar (21 % vs 26 %, p = 0.6). Quality-of-life improvements at 3 and 6 months were comparable between groups. CONCLUSION: Robotic-assisted ventral hernia repair was associated with shorter hospitalization particularly for larger defects. The surgical stress response was also significantly lower following rVHR, but with longer operative time and no differences in complications or patient-reported outcomes. ClinicalTrials.gov NCT05906017, registered May 23 2023.
Open inguinal hernia repair under combined transversalis fascia plane and transversus abdominis plane blocks in a high-risk cardiac patient.
Tamdogan I
Hernia · 2026 Mar · PMID 41915300 · Full text
BACKGROUND: Selecting an optimal anesthetic technique for inguinal hernia repair is particularly challenging in patients with severe cardiac comorbidities and ongoing anticoagulant therapy. General anesthesia may increas...
BACKGROUND: Selecting an optimal anesthetic technique for inguinal hernia repair is particularly challenging in patients with severe cardiac comorbidities and ongoing anticoagulant therapy. General anesthesia may increase cardiopulmonary instability, whereas neuraxial techniques carry risks of hypotension and bleeding complications. CASE PRESENTATION: We report the case of a 76-year-old man with advanced heart failure (ejection fraction 20%), New York Heart Association (NYHA) class III symptoms, pacemaker dependency, and chronic warfarin therapy who underwent elective open right inguinal hernia repair. Ultrasound-guided unilateral transversalis fascia plane (TFP) block (30 mL of 0.25% bupivacaine) combined with a transversus abdominis plane (TAP) block (20 mL of 0.25% bupivacaine) was performed as the sole anesthetic technique. Adequate sensory blockade over T12–L1 dermatomes was achieved within 20 minutes. Surgery using the Lichtenstein technique was completed in 45 minutes with stable hemodynamic parameters, without the need for conversion to general anesthesia, surgical infiltration, or intraoperative opioid supplementation. RESULTS: Postoperative pain was well controlled with multimodal non-opioid analgesia, with numerical rating scale (NRS) scores ≤2 during the first 24 hours. No rescue opioid analgesia was required. The patient had an uneventful recovery and was discharged on postoperative day 2. CONCLUSION: The combination of transversalis fascia plane and TAP blocks may represent a feasible and effective anesthetic alternative for open inguinal hernia repair in carefully selected high-risk cardiac patients in whom general or neuraxial anesthesia is undesirable.
Incisional hernia repair using component separation with perforator preservation and onlay mesh: A pilot study.
Orban YA, Baz Y, Hegab YH … +2 more , Zakaria R, Heggy IA
Hernia · 2026 Mar · PMID 41915292 · Full text
INTRODUCTION: Incisional hernia (IH) is a common complication after abdominal surgeries, whether conventional open or laparoscopic. Despite many efforts to reduce the incidence of IH, there is still a lack of consensus c...
INTRODUCTION: Incisional hernia (IH) is a common complication after abdominal surgeries, whether conventional open or laparoscopic. Despite many efforts to reduce the incidence of IH, there is still a lack of consensus concerning the best approach for its prevention and repair. This pilot study evaluates a technique integrating perforatorpreserving anterior component separation with onlay mesh reinforcement at the midline and lateral external oblique incisions, addressing persistent challenges in tension management, vascular preservation, and recurrence reduction post-abdominal surgery. PATIENTS AND METHODS: This is a prospective pilot study conducted from January 2023 to January 2024 to evaluate the repair of large midline incisional hernias in 17 patients who underwent previous vertical midline incisions due to various indications. We used anterior component separation with perforator preservation along with onlay mesh reinforcement. RESULTS: All cases underwent only mesh fixation. There were no intraoperative complications reported. The reported postoperative complications were wound seroma (41.2%), superficial wound ischemia (5.9%), and wound seroma with superficial wound ischemia (5.9%), while no complications were encountered in the rest of the cases (47.1%). There were no reported cases with deep wound ischemia and/or wound dehiscence. CONCLUSION: The anterior component separation technique with perforator preservation is a feasible and effective method for treating large incisional hernias with difficult midline closures. When paired with onlay mesh reinforcement for both the midline and lateral releasing incision, it provides satisfactory outcomes, low recurrence rates, and a manageable complication profile. The technique of the procedure should be tailored to each patient's specific condition.
Exploring the application of the TAPP procedure for the treatment of upper abdominal ventral hernias.
Pan C, Yu J, Li B … +4 more , Wang S, Zhang C, Ni X, Wang H
Hernia · 2026 Mar · PMID 41915287 · Publisher ↗
PURPOSE: To evaluate the feasibility, safety, and perioperative risk profile of the transabdominal preperitoneal (TAPP) approach in the surgical repair of upper abdominal ventral hernias. METHODS: A retrospective cohort...
PURPOSE: To evaluate the feasibility, safety, and perioperative risk profile of the transabdominal preperitoneal (TAPP) approach in the surgical repair of upper abdominal ventral hernias. METHODS: A retrospective cohort analysis was conducted on patients who underwent laparoscopic TAPP repair for upper abdominal ventral hernias at a single institution between March 2019 and July 2024. All patients were followed for at least 12 months postoperatively. Demographic data, hernia characteristics, operative details, and postoperative outcomes were analyzed. RESULTS: The TAPP procedure was successfully performed on 58 patients. Hernia localization included the M1 zone in 42 cases (72.4%) and the M2 zone in 16 cases (27.6%). In patients with follow-up exceeding 12 months, seroma formation occurred in 3 patients (5.2%). No additional postoperative complications, mesh infections, or hernia recurrences were observed. Patient-reported satisfaction scores indicated favorable functional recovery and cosmetic outcomes. CONCLUSION: Laparoscopic TAPP repair represents a safe, effective, and anatomically sound technique for the management of upper abdominal ventral hernias, demonstrating low morbidity and high patient satisfaction.
Outcomes after extended totally extraperitoneal (eTEP) repair for ventral hernia with or without posterior rectus sheath closure: systematic review.
Bellido-Luque J, Balla A, Rubio Castellanos C … +1 more , Morales-Conde S
Hernia · 2026 Mar · PMID 41915282 · Publisher ↗
PURPOSE: To evaluate perioperative and long-term outcomes of extended totally extraperitoneal repair (eTEP) repair for midline ventral hernias, comparing procedures performed with versus without posterior rectus sheath (...
PURPOSE: To evaluate perioperative and long-term outcomes of extended totally extraperitoneal repair (eTEP) repair for midline ventral hernias, comparing procedures performed with versus without posterior rectus sheath (PRS) closure. METHODS: A systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. After PROSPERO registration (CRD420251083420), a search was performed in MEDLINE, Embase, and Web of Science databases for studies published up to April 2025. Articles were excluded if patients underwent concomitant transversus abdominal muscle release. RESULTS: Five-hundred-fifty-five and 557 patients underwent eTEP without and with PRS closure, respectively. Patient and hernia characteristics were comparable between groups, with most defects appearing to fall within the W1-W2 range according to the European Hernia Society classification. The comparison between the non-closure and closure group showed statistically significant differences in the intraoperative peritoneal tears (2.2% versus 0.5% in the non-closure and closure group, respectively, p = 0.0189), impossibility to close the peritoneum (0.7% versus 0 in the non-closure and closure group, respectively, p = 0.0447), and conversion to open surgery (0.7% versus 0 in the non-closure and closure group, respectively, p = 0.0447). No differences in postoperative interparietal hernias occurred between the two groups. CONCLUSION: Evidence comparing PRS non-closure and closure during eTEP repair remains limited and heterogeneous. Both approaches appear safe and effective, showing comparable intra- and postoperative outcomes; importantly, PRS closure is not associated with an increased risk of interparietal hernias. Current data do not justify a standardized recommendation, and the choice should be individualized based on defect characteristics and surgeon experience.
Effect of mesh plane on short-term surgical and functional outcomes in ventral hernia repair with associated rectus diastasis.
Theis C, Nunes VA, Blackman M … +2 more , Pompeu BF, de Figueiredo SMP
Hernia · 2026 Mar · PMID 41915272 · Publisher ↗
BACKGROUND: Optimal management of diastasis recti in patients undergoing ventral hernia repair remains uncertain, particularly regarding mesh plane selection. We compared wound morbidity and functional outcomes across me...
BACKGROUND: Optimal management of diastasis recti in patients undergoing ventral hernia repair remains uncertain, particularly regarding mesh plane selection. We compared wound morbidity and functional outcomes across mesh locations using a multi-institutional registry. METHODS: Retrospective cohort study using the Abdominal Core Health Quality Collaborative (ACHQC) registry (2015–2025). Eligible patients underwent elective ventral hernia repair with mesh and associated diastasis recti repair, with complete 30-day follow-up. The primary outcome was 30-day surgical site occurrence (SSO). Secondary outcomes included surgical site infection, readmission, reoperation, and patient-reported outcomes (HerQLes and PROMIS Pain Interference). RESULTS: Among 1,209 patients (mean age 55.0 ± 13.6 years, 49.7% female, mean BMI 31.4 ± 6.2 kg/m²), mesh location was retromuscular in 74.3%, intraperitoneal in 11.9%, preperitoneal in 9.3%, and onlay in 4.5%. The overall 30-day SSO rate was 7.8% and varied by mesh plane (p = 0.007): onlay 16.7%, retromuscular 8.4%, intraperitoneal 4.9%, and preperitoneal 2.7%. After multivariable adjustment, onlay placement had fivefold higher odds of SSO compared with retromuscular repair (OR 5.25, 95% CI 1.82–15.16, p = 0.002). Baseline HerQLes was the strongest predictor of postoperative HerQLes (β = 0.39; p < 0.001), but preperitoneal repair was associated with higher adjusted 30-day HerQLes compared with retromuscular repair. Baseline PROMIS predicted postoperative pain, while mesh location was not independently associated with 1-year pain. Onlay repair was performed in patients with lower BMI than retromuscular repair (25.9 vs. 32.0 kg/m²). CONCLUSIONS: Preperitoneal repair demonstrated the most favorable short-term wound profile, whereas onlay mesh placement was associated with higher early wound morbidity despite use in lower–body mass index patients. Baseline functional status was the primary determinant of postoperative quality of life and pain, highlighting the need for prospective studies to define optimal mesh positioning in diastasis recti repair.
Clinical and functional outcomes after laparoscopic IPOM repair: A comparison between hybrid biosynthetic and conventional meshes.
Verbo A, Bez MA, Di Giorgio D … +1 more , Verbo I
Hernia · 2026 Mar · PMID 41880093 · Full text
BACKGROUND: Laparoscopic IPOM repair is widely used for ventral hernia treatment. Hybrid biosynthetic meshes have been developed to improve tissue integration and functional recovery; however, comparative clinical eviden...
BACKGROUND: Laparoscopic IPOM repair is widely used for ventral hernia treatment. Hybrid biosynthetic meshes have been developed to improve tissue integration and functional recovery; however, comparative clinical evidence remains limited. METHODS: This was a single-center retrospective study conducted at a tertiary care institution between 2020 and 2025 including 95 consecutive patients undergoing laparoscopic IPOM repair. Forty-two patients received a hybrid biosynthetic mesh (SINECOR®) and 53 a conventional synthetic mesh. Demographic, clinical and surgical variables were analyzed, including defect size, mesh surface, operative time, complications, length of stay, functional and occupational recovery time, and quality of life (EuraHS-QoL). Hernia defects were classified as small (≤ 20 cm²), medium (21–100 cm²) and large (> 100 cm²). Mesh size was categorized as small (≤ 150 cm²), medium (151–400 cm²) and large (> 400 cm²). Delayed functional recovery was defined as occupational recovery > 30 days. Multivariable logistic regression was performed to identify independent predictors of delayed recovery; covariates included age > 65 years, BMI > 30 kg/m², defect size > 100 cm², mesh surface and mesh type (hybrid vs. conventional). RESULTS: Groups were comparable in BMI (25.8 vs. 25.8 kg/m², p = 0.92), whereas patients in the hybrid group tended to be slightly older (63 vs. 58.5 years, p = 0.08). Follow-up was significantly longer in the control group (46.9 vs. 20.4 months, p < 0.001). No large defects (> 100 cm²) were observed in the hybrid mesh group, while they accounted for about one third of cases in the control group. Despite this imbalance, mean mesh surface did not differ significantly between groups (200.7 vs. 255.9 cm², p = 0.11). Hybrid mesh was associated with significantly shorter operative time (52.3 vs. 79.7 min, p < 0.001), reduced length of stay (2.0 vs. 2.8 days, p = 0.001), faster functional recovery (return to physical activity 10.5 vs. 13.5 days, p = 0.004; return to work 17.0 vs. 25.1 days, p < 0.001), and higher EuraHS-QoL scores (90.2 vs. 80.1, p < 0.001). Overall postoperative complication rates and seroma occurrence were comparable between groups. Recurrence was less frequent in the hybrid group (2.4% vs. 20.8%, p = 0.01) in the context of markedly shorter follow-up. On multivariable analysis, use of hybrid biosynthetic mesh remained the only independent predictor of faster functional recovery (OR 0.09; 95% CI 0.01–0.77; p = 0.028), with acceptable model calibration (Hosmer–Lemeshow p = 0.51; AUC = 0.73). CONCLUSIONS: In laparoscopic IPOM repair, hybrid biosynthetic mesh was associated with improved functional recovery and quality of life for small-to-medium defects, with a safety profile comparable to conventional meshes. Recurrence appeared lower with hybrid mesh, although interpretation is limited by shorter follow-up. Larger prospective studies are warranted to confirm these findings.
The prehabilitation paradox in ventral hernia: from universal to personalized care.
Li J, Pan Y, He M … +3 more , Qi Y, Zhu K, Zhang F
Hernia · 2026 Mar · PMID 41880075 · Full text
PURPOSE: The purpose of this narrative review is to critically examine the paradox in ventral hernia repair (VHR): the widespread clinical adoption of prehabilitation despite limited high-level evidence supporting its un...
PURPOSE: The purpose of this narrative review is to critically examine the paradox in ventral hernia repair (VHR): the widespread clinical adoption of prehabilitation despite limited high-level evidence supporting its universal benefit. We aim to deconstruct this evidence-practice gap and propose a risk-stratified framework to guide future practice and research. METHODS: A comprehensive analysis of contemporary literature on prehabilitation for VHR was conducted, focusing on interventions for obesity, nutrition, physical training and psychological preparation. The drivers of clinical practice beyond evidence were explored. RESULTS: Current evidence is contradictory. Observational studies suggest potential benefits from risk factor modification, yet randomized controlled trials have not consistently demonstrated improved long-term surgical outcomes. This discrepancy may arise from non-individualized interventions, inappropriate outcome measures, and the powerful influence of pathophysiological rationale and publication bias on clinical decision-making. CONCLUSION: A paradigm shifts from universal to precision prehabilitation is needed. We propose a risk-stratified clinical decision framework to direct multimodal prehabilitation toward high-risk patients. Future research must prioritize RCTs in this cohort, employing personalized protocols and patient-centered outcomes.
Anterior to posterior preoperative risk assessment of abdominal thickness compared to BMI in ventral hernias.
Brosnihan PJ, Pihl ET, Reifel AE … +4 more , Choi PK, Chen KT, Moazzez A, Ozao-Choy JJ
Hernia · 2026 Mar · PMID 41874718 · Full text
BACKGROUND: Obesity is a known risk factor for recurrence following ventral hernia repair. BMI is often used to define obesity, and we have previously shown a BMI > 33.67 associated with higher recurrence. In 2023, AMA p...
BACKGROUND: Obesity is a known risk factor for recurrence following ventral hernia repair. BMI is often used to define obesity, and we have previously shown a BMI > 33.67 associated with higher recurrence. In 2023, AMA policy highlighted BMI as an imperfect measurement of obesity and recommended limitations to its use. This study's objective was to evaluate the association between anterior-to-posterior abdominal wall depth (APD) in CT measurements with hernia recurrence as an alternative to BMI. METHODS: Data was retrospectively collected for patients from a county healthcare system, undergoing elective ventral hernia repair from 2014 to 2020 with fascial defects > 4 cm and preoperative CT scans. CART analysis was performed to determine the APD threshold for recurrence. Receiver operating characteristic (ROC) curve analysis was performed to compare APD and BMI as predictors of recurrence. Kaplan-Meier analysis was used to depict the recurrence-free survival period. RESULTS: 267 patients met our inclusion criteria. Mean APD at L4 was 27.67 cm. APD of 29.7 cm was determined as the threshold for recurrence. Area under the curve for APD > 29.7 cm and BMI > 33.67 were 0.617 (p = 0.046) and 0.577 (p=0.189) respectively. Five-year recurrence free survival was 70% for APD ≤ 29.7 cm and 37% for APD > 29.7 cm. CONCLUSION: In our study, the use of APD CT measurements provided an objective, reproducible, and rapid method to augment preoperative evaluation for visceral obesity and the risk for hernia recurrence that was not reliant on traditional BMI, and, in fact, improved upon a simple BMI threshold.
Diagnostic accuracy of upright ultrasonography for groin hernia compared with laparoscopic findings: a single-center study.
Sato M, Torii K
Hernia · 2026 Mar · PMID 41870693 · Publisher ↗
BACKGROUND: Ultrasonography (US) is increasingly used to aid in groin hernia diagnosis, but concerns remain regarding overdiagnosis, subtype misclassification, and limited evidence on orifice size measurement. METHODS: T...
BACKGROUND: Ultrasonography (US) is increasingly used to aid in groin hernia diagnosis, but concerns remain regarding overdiagnosis, subtype misclassification, and limited evidence on orifice size measurement. METHODS: This retrospective diagnostic accuracy study was conducted at a single institution and included 884 patients (1,768 groins) who underwent laparoscopic groin hernia repair between 2007 and 2025. Preoperative upright US was compared with laparoscopic findings as the reference standard. Outcomes included diagnostic accuracy for hernia detection, concordance of subtype classification, and agreement of orifice size measurement. RESULTS: Among 798 groins assessed by upright US, sensitivity, specificity, and negative predictive value were 95.7%, 96.7%, and 93.4%, respectively. Physical examination showed lower sensitivity (89.8%) despite high specificity (99.4%). Subtype classification accuracy reached 91.6% with substantial agreement (Cohen’s κ = 0.791). Lateral inguinal and femoral hernias were identified with high accuracy, whereas combined types were often misclassified. Orifice size measurement by US demonstrated minimal bias (0.65 mm) and proportional agreement with intraoperative findings; 68.7% of groins were within ± 5 mm. Agreement was strongest for lateral inguinal and femoral hernias but limited for medial inguinal hernias. CONCLUSIONS: Upright US provided excellent diagnostic performance and reliable subtype classification, with clinically acceptable concordance in orifice size measurement. When optimized, it can support both diagnosis and surgical planning in groin hernia management.
SILS plus-rives stoppa repair for abdominal wall reconstruction: a hybrid procedure of eTEP and open surgery - results of initial 100 cases.
Nagahama T
Hernia · 2026 Mar · PMID 41863664 · Publisher ↗
PURPOSE: The eTEP Rives-Stoppa repair is effective but technically challenging without robotics. To address these hurdles, we introduced the Single-Incision Laparoscopic Surgery Plus Rives-Stoppa (SILS Plus-RS) method. T...
PURPOSE: The eTEP Rives-Stoppa repair is effective but technically challenging without robotics. To address these hurdles, we introduced the Single-Incision Laparoscopic Surgery Plus Rives-Stoppa (SILS Plus-RS) method. This hybrid technique creates the initial working space under direct vision to facilitate secure access. This study evaluates the safety, long-term efficacy, and flexibility of SILS Plus-RS for ventral hernias. METHODS: This retrospective, single-center study analyzed 100 consecutive patients (91 incisional, 9 primary hernias) undergoing SILS Plus-RS between December 2016 and March 2025. Patients with loss of domain were excluded. The procedure utilizes a single-incision device for retromuscular access and allows for a flexible "hybrid" strategy, employing strategic port addition or open conversion to ensure safety. RESULTS: Mean age was 67.4 years; mean BMI was 25.6 kg/m2. Transversus Abdominis Release (TAR) was performed in 74% to ensure tension-free closure. Median operative time was 203.6 min. Reflecting the technique's flexibility, additional ports were used in 14 cases, and 6 cases were converted to a hybrid open approach. Median follow-up was 33 months (range: 10–110 months), with a recurrence rate of 2.0%. Early complications (< 90 days) occurred in 6.0% (3 SSIs, 2 seromas, 1 fistula). Chronic pain (5.0%) resolved within one year in all patients. CONCLUSION: SILS Plus-RS is a safe and durable procedure with low recurrence and complication rates comparable to eMILOS. By bridging the gap between open and laparoscopic surgery, its inherent flexibility ensures broad applicability, making it a valuable option in non-robotic environments.
Frailty index as a predictive tool for poor outcomes after ventral hernia repair - systematic review and meta-analysis.
Morais MC, de Carvalho Caldas G, de Almeida DPA … +6 more , Pereira MF, Apocalypse J, Cruz LWLC, Nogueira R, Malcher F, Lima DL
Hernia · 2026 Mar · PMID 41863655 · Publisher ↗
INTRODUCTION: Frailty, characterized by reduced physiologic reserve and heightened vulnerability to surgical stress, has emerged as a key predictor of adverse postoperative outcomes. The modified 5-factor frailty index (...
INTRODUCTION: Frailty, characterized by reduced physiologic reserve and heightened vulnerability to surgical stress, has emerged as a key predictor of adverse postoperative outcomes. The modified 5-factor frailty index (mFI-5) offers a simplified yet validated tool for quantifying frailty. While its predictive utility is established in multiple surgical specialties, its role in ventral hernia repair (VHR) has not been comprehensively synthesized. This systematic review and meta-analysis aims to evaluate the clinical utility and discriminative performance of the mFI-5 in VHR by analyzing postoperative outcome patterns among frail and non-frail patients. METHODS: Following PRISMA guidelines, the authors searched PubMed, EMBASE, LILACS, and Cochrane databases from inception up to April 2025. Adult patients undergoing elective VHR were included if outcomes were stratified by mFI-5 frailty status. Data on demographics, hernia characteristics, complications, readmissions, reoperations, length of stay (LOS), and mortality were extracted. Random-effects meta-analyses assessed pooled risk ratios (RR) for key outcomes. Study quality and risk of bias were evaluated using ROBINS-I. RESULTS: Four studies were included in the final analysis, representing 27,312 patients (17,760 non/pre-frail, 9,552 frail/severely frail). Frail patients were older, more comorbid, and more likely to have larger hernias. Meta-analysis demonstrated that frailty was significantly associated with higher 30-day reoperation (RR 1.55; 95% CI 1.22–1.99; p < 0.001). Although absolute mortality rates were low (< 1%) in both groups, the reduction observed in non/pre-frail patients remains clinically relevant in the setting of elective benign surgery. No significant differences were found in pooled rates of surgical site infections or readmissions. Recurrence was only reported in the studies when it was a cause of 30-day reoperation. CONCLUSION: The mFI-5 is a pragmatic and validated tool for stratifying physiologic risk in ventral hernia repair. Even small absolute reductions in postoperative mortality are clinically meaningful in a benign elective operation, underscoring the value of frailty assessment for patient selection and perioperative counseling. Incorporating frailty screening into routine practice may support safer and more personalized hernia care. Future research should refine composite risk models and test interventions to mitigate frailty-related risk while preserving the functional benefits of repair.
Distinguishing abdominal wall denervation injury from normal anatomy via cross section imaging.
Carvalho AC, Bennett WC, Woo KP … +8 more , Tocci NX, Schmidt EM, Tastaldi L, Miller BT, Beffa LR, Petro CC, Krpata DM, Prabhu AS
Hernia · 2026 Mar · PMID 41863648 · Publisher ↗
PURPOSE: To identify objective CT-based measurements of abdominal wall denervation injury and establish an imaging-based assessment framework for abdominal wall denervation syndrome. METHODS: CT scans from patients with...
PURPOSE: To identify objective CT-based measurements of abdominal wall denervation injury and establish an imaging-based assessment framework for abdominal wall denervation syndrome. METHODS: CT scans from patients with unilateral denervation, full-thickness hernia, or intramuscular hernia were retrospectively reviewed using TeraRecon’s Aquarius software. Measurements from the symptomatic side were compared with the contralateral normal side. Axial assessments included EO and TA lengths and abdominal wall thickness, while coronal assessments included muscle length only. Axial slices were also used to evaluate muscle area, mean attenuation in Hounsfield units (HU), and muscle composition. RESULTS: At the point of maximal bulging, denervation was marked by enlargement of the lateral abdominal wall, with significantly increased EO (p < 0.001) and TA (p < 0.001) lengths, and decrease of the abdominal wall thickness when compared to the contralateral normal side; muscle composition also showed greater fat replacement (p = 0.04). Relative to full-thickness and intramuscular hernias, denervation likewise led to increasing length of the EO (p = 0.001) and the TA (p < 0.001); and decreasing measurements of thickness (p < 0.001). Coronal views confirmed EO and TA lengthening of the denervated abdominal wall (p < 0.001). CONCLUSION: Abdominal wall denervation syndrome can be radiologically presumed by a lateral abdominal wall bulge without any muscular defect (hernia). Denervated muscles appear longer, thinner, and show greater intramuscular adipose tissue compared with the contralateral healthy side. These objective CT-based features may serve as imaging criteria to aid the diagnosis of abdominal wall denervation syndrome.
Smoking cessation and weight loss before ventral hernia repair - can we really justify this? A single center cohort study.
Marker L, Fisker A, Helgstrand F
Hernia · 2026 Mar · PMID 41863594 · Full text
PURPOSE: Smoking and adiposity are risk factors for poor postoperative outcomes after hernia surgery. This study evaluated a real-world hospital-based prehabilitation program covering smoking cessation and weight loss pr...
PURPOSE: Smoking and adiposity are risk factors for poor postoperative outcomes after hernia surgery. This study evaluated a real-world hospital-based prehabilitation program covering smoking cessation and weight loss prior to ventral hernia repair. METHODS: In this retrospective single-center cohort study, patients enrolled in a non-standardized smoking cessation or weight loss program prior to ventral hernia repair between June 2021 and December 2024 were included. Patients in the smoking cessation program were offered counseling and motivational interviews by nurse specialists. Patients in the weight loss program received the same in addition to a target weight and dietary guidance. Follow-up occurred every 2–8 weeks according to patient preference. Success was defined as cessation of smoking for ≥ 6 weeks or reaching target weight followed by ventral hernia repair. RESULTS: A total of 107 patients were identified: 12 (11.2%) participated in the smoking cessation program, 77 (72.0%) in the weight loss program, and 18 (16.8%) in both programs. Of these, 28 patients (26.2%) completed prehabilitation and underwent surgery, whereas 28 (26.2%) did not and remained in the program at the end of follow-up. A total of 27 (25.2%) patients dropped out, 14 (13.1%) were discontinued due to lack of progress, 8 (7.4%) were lost to follow-up, and 3 (2.8%) required emergency surgery. The median time from intervention to surgery was 325 days [IQR: 225.3, 496.5]. CONCLUSION: Only one in four patients completed prehabilitation and underwent surgery. The program was resource-intensive, with substantial dropouts and failure rates. These results highlight the challenges associated with preoperative lifestyle modification prior to hernia surgery.
Correction to: India first tele-robotic hernia repairs using the SSI mantra system: a feasibility study.
Bhandari M, Bhandari M, Kosta S … +4 more , Mathur W, Reddy M, Singh M, Bhandari V
Hernia · 2026 Mar · PMID 41863553 · Publisher ↗
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Surgical management and outcomes of complex lateral hernias: a specialized hernia center experience.
Balthazar da Silveira C, Rasador AD, Premkumar A … +6 more , Cogua LM, Salevitz N, Wang H, Deka V, Ballecer C, Gillespie T
Hernia · 2026 Mar · PMID 41863551 · Publisher ↗
INTRODUCTION: Lateral hernias present unique challenges, and understanding treatment modalities is crucial. This study aimed to evaluate lateral hernia management at a specialized center. METHODS: A single-center retrosp...
INTRODUCTION: Lateral hernias present unique challenges, and understanding treatment modalities is crucial. This study aimed to evaluate lateral hernia management at a specialized center. METHODS: A single-center retrospective study on lateral hernia repair was conducted. Key outcomes included intraoperative complications, emergency visits, postoperative pain, wound complications, and recurrence. RESULTS: A total of 93 patients were included, and the mean lateral defect length was 15.1 cm (7.1). Robotic surgery comprised 91.4% of repairs. The conversion-to-open rate was 4.4%, and intraoperative complications occurred in 9 patients. Nine patients (9.7%) required emergency department visits, and two patients (2.2%) subsequently underwent reoperation. The rate of postoperative pain was 37.4%, and 6 patients (6.6%) experienced chronic pain. No early recurrence was observed during a median follow-up of 1 year (0.4–1.6). CONCLUSION: Lateral hernias can be effectively treated with robotic techniques, but achieving optimal outcomes requires approach selection tailored to both patient factors and hernia characteristics. Our findings emphasize the importance of optimization and tailored management in complex hernia repair.
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