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Trunk muscle strength assessment as a predictor of complications in patients undergoing incisional hernia repair.
Bravo-Ratón P, Santos-Sánchez JC, Gil-Delgado JL … +4 more , Sánchez-Arteaga A, Tinoco-González J, Sañudo Corrales B, Tallón-Aguilar L
Hernia · 2026 Mar · PMID 41862747 · Full text
PURPOSE: Incisional hernia is a common condition with significant complication rates. While various risk factors have been studied, the role of preoperative trunk muscle strength in predicting postoperative outcomes rema...
PURPOSE: Incisional hernia is a common condition with significant complication rates. While various risk factors have been studied, the role of preoperative trunk muscle strength in predicting postoperative outcomes remains underexplored. METHODS: This is a prospective cohort study conducted with 75 patients undergoing incisional hernia repair between 1st June 2022 to 31st September 2024. Preoperative trunk muscle strength was assessed by using a strain gauge device, targeting both medial and lateral abdominal muscle groups, and recording force peak (FP) and rate force development (RFD). Patients were followed for 30 days postoperatively, and complications were classified using the Clavien-Dindo classification. Associations between muscle strength and postoperative outcomes, anthropometric variables and comorbidities were analyzed. RESULTS: Mean age was 57.6 years and mean BMI 29.19 kg/m2. Complications were observed in 32% of patients. Sex-related differences were found: men exhibited greater anterior trunk strength (FP90° 193.8 vs 147.4 N, p < 0.003; RFD90° 667 vs 400.9 N/s, p < 0.03). Postoperative bleeding was associated with lateral trunk strength (FP45° 96.0 vs 154.2 N; p < 0.042), and surgical site infection was correlated with anterior strength in male patients (FP90° 149.7 vs 203.8 N; p < 0.03). No significant association was found between bleeding and antiplatelet or anticoagulant therapy. CONCLUSION: Preoperative trunk muscle strength may serve as a useful predictor of postoperative complications in patients undergoing incisional hernia repair. These findings support the potential role of targeted pre-habilitation strategies, in order to improve surgical outcomes.
Robotic management of Morgagni hernias: a case series from a specialized hernia center.
Koza D, Balthazar da Silveira C, DO KL … +4 more , Rasador A, Deka V, Gillespie T, Ballecer C
Hernia · 2026 Mar · PMID 41843318 · Publisher ↗
INTRODUCTION: Morgagni hernias, a rare type of congenital diaphragmatic hernia, are typically asymptomatic and often diagnosed incidentally in adulthood. Despite their infrequent occurrence, surgical intervention is requ...
INTRODUCTION: Morgagni hernias, a rare type of congenital diaphragmatic hernia, are typically asymptomatic and often diagnosed incidentally in adulthood. Despite their infrequent occurrence, surgical intervention is required in symptomatic cases or when complications arise. Traditionally, Morgagni hernias are managed through open surgery. However, recent advancements in robotic surgery offer potential benefits, including enhanced precision, reduced recovery times, and improved outcomes. This case series aims to explore the feasibility, safety, and outcomes of robotic-assisted repair of Morgagni hernias at a specialized hernia center. METHODS: Medical records from all the patients who underwent ventral and Morgagni hernia repair were reviewed from December 2019 to December 2023. Patients with a surgical or radiological diagnosis of Morgagni hernias who underwent robotic repair were included for analysis. The protocol at our institute involves preoperative optimization, and myofascial release may be indicated for complex Morgagni defects associated with midline incisional hernias, while isolated Morgagni hernias are typically repaired by a transabdominal preperitoneal (TAPP) technique. Additionally, robotic repair has become the standard approach at our institution. Outcomes included patient demographics, preoperative symptoms, robotic surgical techniques, defect measurements, concomitant procedures, hospital length of stay (LOS), and postoperative complications. Complications analyzed comprised immediate postoperative and chronic pain, surgical site occurrences (SSO), surgical site infection (SSI), readmission and reoperation, recurrence. RESULTS: A total of 7 patients were identified through records review. The median age was 60 (IQR 53–71) years, and the sample was comprised by 5 (71.4%) females and 2 (28.6%) males. Median body mass index (BMI) was 34.3 kg/m2 (IQR 24.1–38.7). The most common symptom was pain (71.4%), and the majority of the patients presented a history of abdominal or thoracoabdominal surgery (85.7%). The median intraoperative defect length was 8 cm (IQR 6–11) and the median defect width was 4 cm (IQR 4–10). A total of 6 (85.7%) patients presented simultaneous midline incisional hernias, and transversus abdominis release (TAR) was required in 4 (57.1%) patients, while the other 3 (42.9%) patients underwent transabdominal preperitoneal (TAPP) repairs. Immediate postoperative pain was noted in 3 (42.9%) of the patients, of whom 2 (66.6%) underwent TAR. Also, one (14.3%) patient who underwent TAR presented with a seroma that did not require interventions. Within a median follow-up of 284 days (IQR 50–435), no recurrences or chronic pain were noted. One (14.3%) was deceased 6 months postoperatively due to metastatic pancreatic cancer. CONCLUSION: Robotic repair of Morgagni hernias demonstrates a low complication rate, allowing for precise anatomical dissection and yielding excellent outcomes. However, it is a highly complex procedure that, in most cases, should be performed at specialized centers with expertise in this type of repair to ensure optimal results and patient safety.
Mechanical behavior of elastic abdominal binders and semi-rigid corsets under patient-applied forces and physiologically relevant loading.
Mitura K, Pajer M, Kacprzak L … +7 more , Niecikowski P, Wojcik M, Mitura L, Lerchuk O, Khomyak V, Chemerys O, Antosik K
Hernia · 2026 Mar · PMID 41843305 · Publisher ↗
BACKGROUND: Abdominal binders are commonly prescribed after abdominal surgery and hernia repair despite limited evidence supporting their mechanical effectiveness. Elastic abdominal binders and semi-rigid corsets are fre...
BACKGROUND: Abdominal binders are commonly prescribed after abdominal surgery and hernia repair despite limited evidence supporting their mechanical effectiveness. Elastic abdominal binders and semi-rigid corsets are frequently used interchangeably, although their mechanical behavior under physiologically relevant conditions remains poorly defined. AIM: To compare the mechanical behavior of elastic abdominal binders and semi-rigid corsets under patient-applied forces and controlled tensile loading, and to assess their effects on dynamic abdominal circumference and basic respiratory parameters. METHODS: In this prospective observational study, 67 adult patients were sequentially fitted with two elastic abdominal binders and two semi-rigid corsets. Waist circumference was measured at rest, during voluntary abdominal protrusion, and during abdominal drawing-in, both without and with abdominal supports. Patient-applied fastening forces were recorded using a digital force gauge. Bench-top tensile testing evaluated device elongation under incremental loads up to 70 N. Vital capacity and inspiratory capacity were assessed in patients able to perform reproducible spirometry. Paired within-subject analyses were performed. RESULTS: Elastic abdominal binders exhibited pronounced elongation within the range of forces applied by patients and did not reach a mechanically stable region, resulting in only a modest reduction in dynamic abdominal circumference when worn. In contrast, semi-rigid corsets demonstrated limited elongation, rapidly entered a stable load–length plateau at relatively low tensile loads, and reduced dynamic abdominal circumference by approximately 50% compared with elastic binders (p < 0.001). Forces required for further elongation were significantly higher for semi-rigid corsets. No clinically relevant differences in vital capacity or inspiratory capacity were observed between support types. CONCLUSIONS: Elastic abdominal binders and semi-rigid corsets differ fundamentally in mechanical behavior under physiologically relevant loading. Semi-rigid corsets provide superior circumferential stabilization without impairing basic respiratory function. Mechanical properties should be considered when prescribing abdominal supports, as device category alone is insufficient to predict functional stabilization.
Successful repair of a complex flank hernia with a coexisting diaphragmatic hernia using an extraperitoneal mesh repair.
Hosoda K, Kubota K, Shimizu A … +2 more , Notake T, Soejima Y
Hernia · 2026 Mar · PMID 41843203 · Publisher ↗
BACKGROUND: Thoracoabdominal hernias (TH), encompassing abdominal wall hernias such as flank hernias and diaphragmatic hernias, are rare conditions with poorly defined epidemiology and no standardized surgical strategy....
BACKGROUND: Thoracoabdominal hernias (TH), encompassing abdominal wall hernias such as flank hernias and diaphragmatic hernias, are rare conditions with poorly defined epidemiology and no standardized surgical strategy. Repair is technically challenging because it requires reconstruction across distinct anatomical structures, including the diaphragm, ribs, and abdominal wall. Optimal repair methods remain controversial. CASE PRESENTATION: A 70-year-old man with a history of descending aortic aneurysm repair presented with a progressive left flank bulge. Computed tomography revealed a large flank hernia accompanied by diaphragmatic deformation, suggesting a concomitant diaphragmatic hernia. Surgical repair was performed via a previous thoracoabdominal incision. Intraoperatively, dehiscence of the diaphragm from the rib cage was identified. The diaphragmatic defect was primarily closed and reinforced by anchoring the diaphragm to the ribs using full-thickness sutures. Subsequently, the flank hernia was repaired using a modified extraperitoneal mesh repair with wide dissection and cranial fixation of the mesh to the ribs, followed by additional onlay mesh reinforcement. The postoperative course was uneventful, and no recurrence or chronic pain was observed during follow-up. CONCLUSION: Combined reconstruction of the diaphragm and abdominal wall using rib-anchored diaphragmatic repair and extraperitoneal mesh placement may be an effective option for complex thoracoabdominal hernias. This approach enables secure fixation and broad mesh overlap while minimizing postoperative bulging. Further studies are needed to validate its safety, durability, and long-term outcomes.
Plication of fascia transversalis in comparison to no plication to reduce seroma formation post laparoscopic transabdominal preperitoneal repair for direct inguinal hernia : a randomized controlled trial.
Nageeb ME, Nashed GA, Asal AAA … +1 more , Torfa KM
Hernia · 2026 Mar · PMID 41843195 · Full text
PURPOSES: Seroma is a frequent complication after laparoscopic hernias repair. Many techniques have been proposed to mitigate this issue, yet no approach has been standardized. This study aimed to evaluate the effectiven...
PURPOSES: Seroma is a frequent complication after laparoscopic hernias repair. Many techniques have been proposed to mitigate this issue, yet no approach has been standardized. This study aimed to evaluate the effectiveness of transversalis fascia plication to reduce this. METHODS: This randomized controlled trial was conducted at University Hospital from Jule 2024 to October 2025 after approval by the research ethics committee (MS-142-2024), involving adult patients who underwent TAPP repair for direct inguinal hernia. Exclusion criteria were indirect/pantaloon or recurrent hernias, conversion to open surgery, and concurrent procedures. Patients were randomized into two groups by ratio1:1 using computer-generated random sequence with opaque sealed envelopes opened only intraoperative after confirmation of direct hernia: Group A: underwent plication of the fascia transversalis, while the other did not. The primary outcome was the incidence of postoperative seroma. Secondary outcomes included postoperative recovery parameters and the complications. Secondary outcomes included postoperative recovery parameters and the complications.Statistical analysis was performed using SPSS version 27. RESULTS: 146 patients met the inclusion criteria. Demographic characteristics, preoperative comorbidities and hernia size were similar across both groups. At day 30 follow-up, 9 patients (12.3%) in the control group developed clinically detectable seromas, whereas none were in the plication group (p =0.002). Additionally, the plication group demonstrated a significantly faster return to normal activity and better pain scores. CONCLUSIONS: Plication of the transversalis fascia during TAPP may reduce the incidence of seroma formation, and improve postoperative outcomes. Before starting the study, the trial was registered and approved by institutional research ethics committee (MS-142-2024).online, retrospectively registered on the Pan African Clinical Trials Registry (PACTR202511671623081).
Laparoscopic application of intraoperative fascial traction (fasciotensⓇHernia) during loss of domain scrotal hernia repair: A European multicenter case series with technical details and preliminary results.
Barbosa E, Barone G, Bertoglio CL … +6 more , Schrempf MC, Mazgaldzhi M, Mones T, Sardoschau N, Catena F, Campanile FC
Hernia · 2026 Mar · PMID 41843194 · Full text
AIM: To describe the laparoscopic intraoperative fascial traction (IFT) in the repair of scrotal hernia with loss of domain (LoD), focusing on the prevention of abdominal compartment syndrome (ACS). METHODS: A multicente...
AIM: To describe the laparoscopic intraoperative fascial traction (IFT) in the repair of scrotal hernia with loss of domain (LoD), focusing on the prevention of abdominal compartment syndrome (ACS). METHODS: A multicenter retrospective analysis was conducted on nine consecutive patients with S2 and S3 LoD scrotal hernia, eligible for IFT, treated between November 2023 and August 2024 in eight European hospitals (Italy, Germany and Portugal). Technical details of laparoscopic IFT were documented. Postoperative intra-abdominal pressure (IAP), ventilatory parameters, complications, and recurrence were assessed. RESULTS: The median Tanaka index was 0.57 and all patients underwent Lichtenstein repair; in two cases, a simultaneous preperitoneal mesh was added due to extensive inguinal defects. Median operative time was 210 min, with median IFT duration of 70 min and a traction force of 18 kg. Postoperative ACS did not occur. IAP was monitored in 55% of patients, with a median postoperative value of 11.4 mmHg. The median peak ventilation pressure before and after hernia reallocation was 16 and 19.5 mmHg respectively with a median differential of 3,5 mmHg (range 0-8). The median Intensive Care Unit (ICU) monitoring was 1 day, and the median hospital stay was 9.5 days. Five patients developed Clavien-Dindo grade I and II complications, with no recurrence detected after a median follow-up of 19 months. CONCLUSION: The laparoscopic IFT is a safe and useful adjunct in the surgical repair of LoD scrotal hernias. IFT may reduce the need for preoperative pneumoperitoneum and possibly prevent the development of postoperative ACS.
Comparıson of analgesıc effectıveness of ultrasound-guıded caudal epıdural block and transversus abdomınıs plane block ın chıldren undergoıng unılateral ınguınal hernıa repaır: randomized controlled study.
Kaçmaz M, Yandım Ö
Hernia · 2026 Mar · PMID 41838259 · Full text
OBJECTIVES: The introduction of ultrasound-guided nerve blocks has led to significant advancements in pediatric postoperative analgesia. In this context, the caudal block (C), a well-established and effective analgesic t...
OBJECTIVES: The introduction of ultrasound-guided nerve blocks has led to significant advancements in pediatric postoperative analgesia. In this context, the caudal block (C), a well-established and effective analgesic technique used for many years, has been increasingly complemented by the transversus abdominis plane (TAP) block, which is thought to have fewer side effects and potentially greater efficacy. The aim of our study was to compare these two methods in terms of postoperative analgesic effectiveness. MATERIALS AND METHODS: This study was conducted as a prospective, randomized, controlled trial. A total of 56 children, aged 1 to 10 years, classified as ASA I and II, undergoing elective inguinal hernia repair, were included. The patients were randomly assigned into two groups. Group T (n = 28) received a TAP block with 0.5 mL/kg of 0.25% bupivacaine under ultrasound guidance, while Group C (n = 28) received a caudal block with the same concentration and volüme of bupivacaine. The primary outcome of the study was the duration of postoperative analgesia, while secondary outcomes included the need for rescue analgesics, complications, and the effects on hemodynamic parameters. RESULTS: During the postoperative period, adequate analgesia was achieved in both groups for up to the first 4 h. However, after the 6th hour, there was a significant increase in pain scores in the caudal block group. The need for rescue analgesics was lower in the TAP group, although there was no difference in the total amount of analgesics used at 12 h. CONCLUSION: Both TAP block and caudal block are effective in providing postoperative analgesia for children undergoing inguinal hernia repair. The TAP block may be preferred due to its longer-lasting postoperative effect and lower need for rescue analgesics.
The application of single-hole laparoscopic repair with slow-absorbable suture in the treatment of indirect inguinal hernia in children.
Wang C, Zheng Y, Feng Q
Hernia · 2026 Mar · PMID 41838249 · Full text
BACKGROUND: The choice of suture material for laparoscopic high ligation of pediatric indirect inguinal hernia remains debated. While non-absorbable sutures are traditionally preferred to minimize recurrence, they pose p...
BACKGROUND: The choice of suture material for laparoscopic high ligation of pediatric indirect inguinal hernia remains debated. While non-absorbable sutures are traditionally preferred to minimize recurrence, they pose potential long-term risks as permanent foreign bodies, including suture reaction and theoretical oncogenic concerns. Recent expert consensus suggests absorbable sutures may be a viable alternative, though comparative evidence, particularly for slow-absorbable variants, is limited. OBJECTIVE: This study aimed to compare the surgical outcomes, specifically recurrence rates and suture-related complications, between slow-absorbable (Polydioxanone, PDS) and non-absorbable (MERSILK) sutures in single-port laparoscopic indirect inguinal hernia repair in children. METHODS: A retrospective analysis was conducted on 1022 children with unilateral indirect inguinal hernia who underwent surgery at our center between October 2022 and October 2023. Patients were divided into two groups based on the suture material used: a slow-absorbable suture group (n = 663) and a non-absorbable suture group (n = 359). Patient demographics, operative details, and postoperative complications (recurrence and suture knot reaction) were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for recurrence. RESULTS: The recurrence rate was 2.0% (13/663) in the slow-absorbable suture group and 0.8% (3/359) in the non-absorbable suture group; this difference was not statistically significant (P = 0.197). Multivariate analysis confirmed that suture type was not an independent risk factor for recurrence [OR = 1.898, 95% CI: 0.475-7.583, P = 0.365]. In contrast, a statistically significant higher incidence of suture knot reaction was observed in the non-absorbable group (0.8% vs. 0%, P = 0.043). Patient age and the internal ring diameter of theprocessus vaginalis were identified as significant independent risk factors for recurrence (P < 0.001 and P = 0.001, respectively). CONCLUSION: The use of slow-absorbable sutures (PDS) for laparoscopic indirect inguinal hernia repair in children does not significantly increase recurrence rates compared to non-absorbable sutures (MERSILK), while effectively eliminating the risk of suture knot reactions. Recurrence is primarily determined by patient age and internal ring diameter, not suture absorbability. Slow-absorbable sutures present a safe and effective alternative, alleviating long-term foreign body concerns without compromising surgical success.
The role of perioperative tapentadol in inguinal hernia repair: Implications for acute analgesia and chronic postoperative pain - a narrative review.
Jurdičová M, Fricová J, Masopust V … +3 more , Rokyta R, Stříteský M, Anders M
Hernia · 2026 Mar · PMID 41838243 · Full text
BACKGROUND: Chronic postoperative inguinal pain remains one of the most frequent complications after inguinal hernia repair. Tapentadol, with its dual mechanism of µ-opioid receptor agonism and noradrenaline reuptake inh...
BACKGROUND: Chronic postoperative inguinal pain remains one of the most frequent complications after inguinal hernia repair. Tapentadol, with its dual mechanism of µ-opioid receptor agonism and noradrenaline reuptake inhibition, offers potential advantages in controlling both nociceptive and neuropathic components of pain. METHODS: This narrative review summarizes experimental, preclinical, and clinical evidence on the use of tapentadol in perioperative analgesia, with focus on inguinal hernia surgery and prevention of chronic postoperative inguinal pain (CPIP). Relevant randomized trials, observational studies, and mechanistic data were evaluated. RESULTS: Available evidence suggests that tapentadol provides effective postoperative analgesia with a favorable gastrointestinal and central nervous system tolerability profile compared with traditional µ‑opioid agonists. Preemptive administration may reduce acute postoperative pain, opioid rescue requirements, and the risk of transition to chronic pain in high‑risk settings. CONCLUSION: Current evidence supports tapentadol as an effective component of perioperative analgesia in inguinal hernia surgery, particularly for reducing acute postoperative pain and opioid rescue requirements. However, its potential role in preventing chronic postoperative inguinal pain remains insufficiently established and should be considered hypothetical, pending confirmation from high-quality randomized controlled trials.
Do patient-reported outcomes reliably screen for radiographic hernia recurrence? External validation of the ventral hernia recurrence inventory.
Carvalho AC, Bennet WC, Schmidt EM … +8 more , Tocci NX, Tastaldi L, Miller BT, Beffa LR, Rosen MJ, Krpata DM, Prabhu AS, Petro CC
Hernia · 2026 Mar · PMID 41838198 · Publisher ↗
IMPORTANCE: The Ventral Hernia Recurrence Inventory (VHRI) was developed to establish a relationship between patient-reported outcomes and hernia recurrence after repair. Positive responses have subsequently been adopted...
IMPORTANCE: The Ventral Hernia Recurrence Inventory (VHRI) was developed to establish a relationship between patient-reported outcomes and hernia recurrence after repair. Positive responses have subsequently been adopted as a screening mechanism for recurrence for patients that are unable to attend follow-up visits. OBJECTIVE: We aimed to externally validate the VHRI compared with recurrences identified on cross-sectional imaging. DESIGN: This is a retrospective analysis of patients that have undergone abdominal hernia repairs between 2014 and 2023 and had completed at least 1 year of follow-up from their index surgery. SETTING: Ventral hernia repairs and corresponding imaging analyses were carried out by surgeons with fellowship training in abdominal wall reconstruction. PARTICIPANTS: Patients included in this cohort were also included in previously published clinical trials and retrospective cohorts with VHRI responses captured within 4 months of cross-sectional imaging. All reviewed images were obtained at least 1 year after the index surgery, up to a maximum of 4 years. MAIN OUTCOMES: The primary outcome was the sensitivity and positive predictive value of the VHRI for detecting imaging-confirmed recurrence. RESULTS: In 2236 patients, 577 patients had 604 sets of corresponding VHRI responses and cross-sectional images, yielding 70 imaging recurrences for a rate of 12% (95% CI: 9%–14%). More patients that had recurrences answered “no” to the question “Do you see or feel a bulge?” (41 vs. 29; p < 0.01). Regarding the survey’s ability to screen for imaging recurrence, analysis showed a sensitivity and positive predictive value of 41% and 21% for “Do you see or feel a bulge?”, 28% and 20% for “Do you think your hernia has come back?”, and 43% and 16% for “Do you have any physical symptoms or pain at the site?”. When all three questions were used together—defining recurrence as a “yes” to any question—the sensitivity increased to 66% and the positive predictive value was 14%. CONCLUSION AND RELEVANCE: These findings suggest that the VHRI tool has a relatively low sensitivity and PPV when used as a screening tool for recurrences identified on cross-sectional imaging. Future work should focus on the discordance between patient-reported outcomes and recurrences identified on imaging.
Retrospective empirical analysis of the success rate of inguinal hernia operations in outpatient and inpatient sectors: a cohort study.
Wiemschulte J, Messerle R, Schreyögg J
Hernia · 2026 Mar · PMID 41838197 · Full text
INTRODUCTION: In Germany, the proportion of outpatient surgeries was low during the study period (2014-2019) and low by international standards. Less than 20% of inguinal hernias are treated on an outpatient basis. Hybri...
INTRODUCTION: In Germany, the proportion of outpatient surgeries was low during the study period (2014-2019) and low by international standards. Less than 20% of inguinal hernias are treated on an outpatient basis. Hybrid DRGs are intended to promote outpatient treatment, but their impact on the quality of care and referral criteria has not been sufficiently investigated empirically. METHODS: A retrospective analysis of routine data included 90,512 cases from 41 company health insurance funds, spanning 2014 to 2019. These were analysed descriptively in terms of care sector, age, and surgical procedure, as well as through two logistic regressions on reoperations and complications, including interaction effects. RESULTS: The proportion of outpatient surgeries is already below 40 % in adults and continues to decline with increasing age. The choice of procedure differs significantly between sectors. The regressions explain only 3.3 % and 4 % of the variance, respectively, meaning that the variables have only a minor impact on the success of the surgery. Inpatient surgeries are associated with fewer reoperations and more complications, although the absolute effect size is small. The surgical procedures have a significant influence. There are no relevant interaction effects between the choice of sector and the other variables. DISCUSSION: A sector-specific allocation based on the analysed parameters cannot be justified based on evidence. Since inpatient procedures do not show consistent superiority, there is no medical advantage over outpatient procedures. A cost-adjusted design of hybrid DRGs appears necessary to enable indication-appropriate procedure selection and to avoid potential misguided incentives that compromise the quality of care.
Association of robotic surgical approach with decreased inpatient opioid exposure after abdominal wall reconstruction: a retrospective cohort study.
Yang S, Yang Y, Guan R … +4 more , Zhang Y, Chiu CJ, Meneghetti AT, Liu Hennessey RQ
Hernia · 2026 Mar · PMID 41838189 · Publisher ↗
PURPOSE: Reduction in postoperative pain with adoption of the robotic platform has been shown in other surgical specialties, but this has not been demonstrated in hernia surgery. We compared postoperative opioid use afte...
PURPOSE: Reduction in postoperative pain with adoption of the robotic platform has been shown in other surgical specialties, but this has not been demonstrated in hernia surgery. We compared postoperative opioid use after open and robotic-assisted abdominal wall reconstruction (AWR). METHODS: A retrospective cohort analysis of all patients with ventral hernias between 4 to 28 cm who underwent open or robotic AWR from January 2020 to May 2024 was completed. Patient characteristics, surgery information, postoperative opioid use, and pain scores were reviewed. RESULTS: 114 patients underwent open and 63 underwent robotic AWR. There was no difference in sex distribution, BMI, and hernia diameter. The robot group was younger (60.1 +/-12.7 vs. 65.0 +/- 12.7, P = 0.02), with a lower ASA class (P = 0.04). Median total inpatient opioid use (in mg oral morphine equivalent) was higher for open repairs (65.7 (15.0-159.0) vs. 15.0 (0-60.0), P < 0.001). Multivariable logistic regression analysis indicates robotic surgical approach as a protective factor against high total (OR = 0.10 (0.03, 0.31), P < 0.001) and high daily (OR = 0.32 (0.11, 0.87), P = 0.03) opioid use. Subgroup analysis of posterior component separation cases demonstrates the robotic approach is a protective factor against high total (OR = 0.11 (0.02, 0.44), P = 0.004) but not high daily (OR = 0.45 (0.13, 1.50), P = 0.20) opioid use. There was no significant difference in pain scores, short-term major complications, or hernia recurrence. CONCLUSION: Open AWR patients had higher total inpatient postoperative opioid exposure. Future studies should further explore the potential of the robotic approach at minimizing postoperative opioid exposure.
Redo TEP in recurrent inguinal hernia After TEP/TAPP: Outcomes and feasibility.
Tabriz N, Khmara D, Weyhe D
Hernia · 2026 Mar · PMID 41838187 · Full text
PURPOSE: The optimal management of recurrent inguinal hernia following previous laparoendoscopic repair lacks robust scientific evidence and varies across guidelines. Due to a paucity of data, the European Hernia Society...
PURPOSE: The optimal management of recurrent inguinal hernia following previous laparoendoscopic repair lacks robust scientific evidence and varies across guidelines. Due to a paucity of data, the European Hernia Society currently recommends open anterior repair for the management of recurrent inguinal hernias after a previous laparoendoscopic repair, based solely on expert opinion. However, repeat endoscopic repair can yield favorable outcomes in experienced hands. This study aimed to compare patient outcomes between repeat endoscopic repair (ReTEP) and the Lichtenstein technique for recurrent hernias after initial TAPP or TEP. METHODS: Adult patients undergoing surgery for first recurrence after laparoendoscopic repair were included. Intra- and postoperative morbidity was analyzed retrospectively, and symptoms and quality of life were assessed prospectively using clinical and ultrasound examination, the Carolinas Comfort Scale (CCS), and the COMI (Core Outcome Measurement Index)-Hernia questionnaire. RESULTS: Between January 2012 and March 2020, the center performed 48 ReTEPs and 45 Lichtenstein hernioplasties for the first recurrence of inguinal hernia after primary endoscopic surgery. Both groups were generally comparable in terms of age, BMI and intrinsic perioperative risk factors. The rate of conversion from ReTEP to Lichtenstein procedure was 27,3%, remained consistent over the years and showed no correlation with surgeon’s expertise. There were no statistically significant differences in the frequency and severity of complications between ReTEP and Lichtenstein. The Lichtenstein procedure was significantly superior in the categories “foreign body sensation” and “pain” assessed using the CCS and the second recurrencies were more frequently observed after ReTEP. CONCLUSION: The findings support the expert suggestion of HerniaSurge group regarding the change of procedure for managing recurrent inguinal hernia following initial endoscopic surgery. In this case the Lichtenstein operation should be considered.
One operation, two challenges: systematic review and single arm proportional meta-analysis of concurrent enterocutaneous fistula takedown and ventral hernia repair.
Lyons G, Dos Santos Neves V, da Silva de Carvalho L … +6 more , Marino IW, Eguchi M, Nogueira R, Jr Docimo S, Lima DL, Malcher F
Hernia · 2026 Mar · PMID 41811568 · Publisher ↗
BACKGROUND: Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and skin, often arising postoperatively or due to inflammatory diseases, malignancies, trauma, or radiation. Based on...
BACKGROUND: Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and skin, often arising postoperatively or due to inflammatory diseases, malignancies, trauma, or radiation. Based on etiology, anatomical factors, and patient conditions, their management can differ. Patients with ECF frequently present with concurrent ventral hernia. Repairing the hernia during ECF takedown is debated due to contamination, dense adhesions, and prior operations that raise complication and recurrence risks. This study aims to analyze the treatment of ventral hernia in patients with ECF focusing on postoperative complications, including surgical site infection, hernia recurrence, fistula recurrence, reoperation, and mortality. METHODS: The study was conducted following a comprehensive search in PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science. A search strategy was performed until its conclusion in March 2025. Studies including patients ≥ 18 years with ECF and ventral, or incisional hernia were eligible. Data on patient demographics, ECF etiology, treatment strategies, surgical outcomes, recurrence and mortality were extracted and analyzed individually. Single-arm proportional meta-analyses were performed in R. Mortality was pooled with a binomial GLMM (logit). Surgical Site Infection (SSI), hernia recurrence, fistula recurrence, and reoperation used inverse-variance random-effects models on the logit scale. Results are reported as pooled proportions with 95% CIs. Quality assessment was evaluated with the ROBINS-I tool. RESULTS: The initial search provided 1,115 studies, and 9 met the inclusion criteria after screening and full-text analysis. A total of 697 patients were analyzed in the included studies, with a mean age of 57 years (standard deviation of 14.9), 55.1% male, and an average body mass index of 28.5 kg/m2 (SD 7.3). All patients underwent simultaneous ECF treatment and abdominal wall repair. Mesh was used in 476 patients (68.3%), including 265 biologic (38%), 169 synthetic (24.2%), 42 biosynthetic (6.1%). Pooled rates were: SSI 41% (95% CI: 0.28–0.56; I² = 85.6%), hernia recurrence 27% (95% CI: 0.19–0.37; I² = 81.4%), fistula recurrence 9% (95% CI: 0.05–0.16; I² = 71.8%), reoperation 14% (95% CI: 0.07–0.26; I² = 86.6%), and mortality 2% (95% CI: 0.01–0.06; I² = 12.4%). Follow up varied from 1 to 153 months across the studies. CONCLUSION: The management of ECF in the context of abdominal wall repair remains challenging, with high rates of SSI, hernia and fistula recurrence. Mesh reinforcement, predominantly in a sublay position, was used in most cases, yet recurrence rates highlight the need of a better timing for a proper surgical repair.
Correction to: Comment to: Effect of an abdominal binder on postoperative outcomes after ventral hernia repair.
Ormseth BH, Janis JE
Hernia · 2026 Mar · PMID 41811542 · Publisher ↗
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Analysis of cardiopulmonary function characteristics and related factors in patients with hiatal hernia.
Lin X, Shen Q, Qin J … +5 more , Liu X, Wu H, Chen J, Xu Q, Yu J
Hernia · 2026 Mar · PMID 41811527 · Publisher ↗
BACKGROUND: Hiatal hernia (HH), a common digestive disease, may impact the respiratory system, but systematic evaluation of its effect on cardiopulmonary function and associations with clinical indicators remains insuffi...
BACKGROUND: Hiatal hernia (HH), a common digestive disease, may impact the respiratory system, but systematic evaluation of its effect on cardiopulmonary function and associations with clinical indicators remains insufficient. METHODS: This retrospective study included 248 HH patients (118 surgical [SHH], 130 non-surgical [NHH]) and 516 healthy controls (HC) from The First Affiliated Hospital of Zhejiang University School of Medicine (January 2021-December 2024). Data on basic information, imaging, pulmonary function, echocardiography, and reflux symptoms were collected. Differences in cardiopulmonary function among groups were compared through multi-factor adjustment analysis, and related influencing factors were explored. RESULTS: HH patients had higher pulmonary infection risk, poorer ventilatory/small airway/diffusing function, and wider pulmonary artery (PA) diameter. NHH patients were older, had larger hernia sacs, and worse cardiopulmonary function but fewer reflux symptoms. The differences in cardiopulmonary function among the above groups weakened after excluding confounding factors such as age. Advanced age and large hernia sac (not reflux) correlated with impaired cardiopulmonary function. 81.2% of SHH patients had improved postoperative respiratory symptoms. CONCLUSION: HH is associated with cardiopulmonary dysfunction, manifested by increased risk of pulmonary infection, restrictive ventilatory dysfunction, decreased diffusing capacity, and widened PA diameter. These associations are not significantly associated with reflux and mainly related to age and hernia sac size. This study has limitations due to its retrospective design and can only provide preliminary data reference for exploring the cardiopulmonary function characteristics of HH and their related influencing factors.
Abdominal wall muscle remodeling after open transversus abdominis release: a CT-based analysis.
Macret JZ, de Freitas Amaral PH, Dias ERM … +3 more , de Carvalho JPV, Rondini GZ, Roll S
Hernia · 2026 Mar · PMID 41811523 · Full text
PURPOSE: To evaluate abdominal wall muscle remodeling after posterior component separation using the transversus abdominis release (TAR) technique, and to explore potential associations between muscle remodeling and clin...
PURPOSE: To evaluate abdominal wall muscle remodeling after posterior component separation using the transversus abdominis release (TAR) technique, and to explore potential associations between muscle remodeling and clinical, demographic, and anatomical variables. METHODS: This retrospective study included adults with incisional ventral hernia who underwent abdominal wall reconstruction with TAR between 2019 and 2023. Pre- and postoperative abdominal CT scans (≥ 6 months) were analyzed to measure bilateral cross-sectional areas of the rectus abdominis (RA), internal oblique (IO), and external oblique (EO) muscles at L3–L4 level. Percentage variation in muscle cross-sectional area (CSA), calculated using bilateral mean values, was used to characterize morphometric remodeling. Associations with demographic factors, clinical variables, hernia characteristics, and postoperative outcomes were assessed using Wilcoxon and Spearman tests. RESULTS: Thirty-seven patients met inclusion criteria. Paired analyses demonstrated a consistent postoperative increase in CT-derived muscle CSA across RA, IO, and EO (all p < 0.001). In exploratory analyses, no demographic, clinical, or anatomic variable demonstrated a statistically significant association with bilateral mean muscle remodeling. CONCLUSION: Patients undergoing open TAR demonstrate consistent postoperative abdominal wall morphometric remodeling on CT, characterized by RA expansion and coordinated changes in the oblique muscles following midline restoration. The clinical significance of these imaging findings remains uncertain and warrants prospective studies integrating functional outcomes.
A practical algorithm for the combined use of preoperative progressive pneumoperitoneum and botulinum toxin A in large incisional hernia repair: learnings after 15 years of experience.
Bueno-Lledó J, Carreño-Sáenz O, Quevedo-Cruz D … +6 more , Serrano-Molina A, Martinez-Hoed J, Bonafé-Diana S, Pareja-Ibars V, Garcia-Pastor P, Pous-Serrano S
Hernia · 2026 Mar · PMID 41811520 · Publisher ↗
INTRODUCTION: Large incisional hernias (LIHs), particularly those with loss of domain (LOD), are associated with substantial morbidity, reduced quality of life, and complex operative management. The aims of this study ar...
INTRODUCTION: Large incisional hernias (LIHs), particularly those with loss of domain (LOD), are associated with substantial morbidity, reduced quality of life, and complex operative management. The aims of this study are to describe a high‑volume abdominal wall unit’s 15 years of experience using a combined botulinum toxin type A (BTA) and preoperative progressive pneumoperitoneum (PPP) protocol in patients with LIHs, to analyze perioperative outcomes and complications in these patients, and to propose a pragmatic algorithm for the selection of these preoperative techniques. METHODS: The inclusion criteria stipulated that all study patients should be aged ≥ 18 years, have a ventral or incisional hernia with a fascial defect ≥ 10 cm in transverse diameter and/or a hernia sac volume (VIH) / abdominal cavity volume (VAC) ratio ≥ 20% on preoperative CT, and have plans for elective reconstruction with curative intent. Patients with small-to-medium defects without LOD or laparoscopic repairs were excluded. RESULTS: Two hundred and twenty consecutive patients with LIHs and LOD who had undergone elective repair between June 2010 and December 2024 were analyzed. A combination of PPP and BTA was performed in all patients. A significant average reduction of 14% (p = 0.001) of the VIH/VAC ratio was observed on CT after a combination of PPP and BTA was performed. Several reconstructive techniques were carried out, but the most frequent method of hernia repair was Rives-Stoppa repair. At postoperative follow-up, which averaged 33.5 months (range: 11–60 months) after surgery, 20 cases (9%) of hernia recurrence were reported. In patients with LIHs that are without LOD (VIH/VAC < 20%) but with W3 transverse defects (≥ 10 cm), BTA alone may be sufficient to facilitate fascial closure. In contrast, when the VIH/VAC ratio is ≥ 20% (especially in patients with true LOD), PPP should be added to progressively adapt diaphragmatic and respiratory mechanics. CONCLUSIONS: PPP and BTA represent complementary tools for the prehabilitation of patients with LIHs. Their combined use in a standardized protocol increases the likelihood of tension‑free primary fascial closure, maintaining acceptable morbidity.
Prospective, randomized, controlled trial comparing self-gripping and conventional mesh in laparoscopic totally extra peritoneal inguinal hernia repair.
Shin S, Park J
Hernia · 2026 Mar · PMID 41811387 · Publisher ↗
PURPOSE: To evaluate the clinical outcomes of self-gripping mesh (SGM) in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. METHODS: Ninety-five patients were randomly divided into two groups based on th...
PURPOSE: To evaluate the clinical outcomes of self-gripping mesh (SGM) in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. METHODS: Ninety-five patients were randomly divided into two groups based on the type of mesh used: tacker-fixed conventional mesh (n = 48) and SGM (n = 47). The Carolina Comfort Scale (CCS), International Prostate Symptom Score (IPSS), postoperative complications, physical findings, and other clinical parameters were analyzed 1 week and 3 months postoperatively. RESULTS: The two groups showed no significant differences in preoperative or postoperative discomfort at 1 week and 3 months. The reduction in discomfort was also similar between the two groups at both timepoints. The operating time, preoperative IPSS, and postoperative IPSS did not differ significantly at 1 week; however, the incidence of postoperative physical findings showed a significant difference at 1 week, with 12 cases in the conventional mesh group and 23 cases in the SGM group. The number of positive physical findings (abdominal wall induration and tenderness) at 1 week was significantly higher with SGM, but had converged by 3 months. Postoperative complications at 1 week occurred in six and two patients, respectively. No recurrence was observed in either group at 3 months. CONCLUSION: The SGM group had a higher incidence of postoperative physical findings at 1 week; however, by 3 months, these findings had mostly resolved, resulting in no significant long-term differences between the two groups.
Cruciate gear suture: a simple and effective technique for pseudo-sac management in TAPP.
Mei J, Liu J, Lin K … +3 more , Luo F, Chen X, Yang C
Hernia · 2026 Mar · PMID 41807722 · Publisher ↗
PURPOSE: To evaluate the Cruciate Gear Suture (CGS) technique for pseudo-sac management in transabdominal preperitoneal prosthesis (TAPP) repair of direct inguinal hernias. METHODS: A prospective randomized controlled si...
PURPOSE: To evaluate the Cruciate Gear Suture (CGS) technique for pseudo-sac management in transabdominal preperitoneal prosthesis (TAPP) repair of direct inguinal hernias. METHODS: A prospective randomized controlled single-center trial was undertaken on adult patients with primary direct inguinal hernia from April to August 2025. A computer-generated random number table assigned patients to the CGS (experimental) and single-hand four-needle suture (control) groups. The primary and secondary outcomes encompassed management time for the pseudo-sac, total operation duration, length of hospital stay, medical expenses, postoperative 24-h Visual Analog Scale (VAS) score, one-week postoperative Carolina Comfort Scale (CCS) score, incidence of seroma, and recurrence rate. SPSS 31.0 was used for data analysis. RESULTS: The trial included 53 patients (71 pseudo-sacs), 26 in the experimental group and 27 in the control group. Baseline factors (age, BMI, comorbidities, hernia defect size) were not significantly different across groups (P > 0.05). CGS had a substantially shorter pseudo hernia sac suturing time than the control group [188 (165, 213.5) s vs 220 (195, 281) s, Z = −2.929, P = 0.003]. Subgroup analyses showed further benefits for 2–3 cm (Z = −2.700, P = 0.006) and 3–4 cm (Z = −2.088, P = 0.036) defects. Total operation time, 24-h VAS score, hospital stay, medical expenses and one-week postoperative CCS score did not differ (P > 0.05). With an average follow-up period of 4.85 months, no significant differences were observed in the duration of postoperative groin irritation (P > 0.05), and the incidence of seroma and recurrence rates were 0% in both groups. CONCLUSION: The CGS technique significantly reduces pseudo-sac suturing time while maintaining comparable safety, efficacy, and cost-effectiveness to the conventional single-hand four-needle group.
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