Hernia[JOURNAL]
Sun
200 papers
Intraoperative adverse events and management strategies in laparoscopic enhanced-view totally extraperitoneal repair (eTEP): a guide to safe introduction.
Filser J, Obrecht I, Steinemann DC … +7 more , Angehrn F, Meir M, Jurowich C, Germer CT, Müller BP, Süsstrunk J, Baur J
Hernia · 2026 Jul · PMID 42397606 · Full text
BACKGROUND: Enhanced-view totally extraperitoneal repair (eTEP) is a promising minimally-invasive technique for ventral hernia repair, allowing extensive retromuscular dissection and large mesh placement with low rates o...
BACKGROUND: Enhanced-view totally extraperitoneal repair (eTEP) is a promising minimally-invasive technique for ventral hernia repair, allowing extensive retromuscular dissection and large mesh placement with low rates of wound complications and a fast recovery. The learning curve, however, is substantial and technical expertise is crucial for satisfying outcomes. The aim of this study is to critically analyse intraoperative adverse events and provide guidance for safe introduction of eTEP. MATERIALS AND METHODS: All patients undergoing eTEP for primary or incisional ventral hernias between October 2023 and December 2024 at three centres were included in this prospective study. eTEP was divided in 10 surgical steps and each was rated for its difficulty (1-5 points) and analysed for the incidence of adverse events. Surgeon workload was measured using the NASA-Task-Load-Index (0-100) and perioperative outcomes were reported. RESULTS: A total of 125 patients with a median BMI of 31 kg/m and 30% female sex were included. Dissection of the hernia and steps involving suturing of the hernia orifice or posterior defects were rated as most difficult. The most common minor adverse events were peritoneal injury during hernia dissection (52%) and minor bleeding during rectus sheath dissection (up to 45%). Critical intraoperative events were common and included injury to the linea alba (6.4%), major bleeding during posterior rectus sheath dissection (up to 4.8%), conversion to open surgery (2.4%) or hybrid procedure (5.6%). Median operation time was 92 min, median length of stay was 2 days. Surgical revisions were necessary in 3.4%. Median overall procedural workload using the NASA raw score was 39.5/100, strongly correlating with operative time. CONCLUSION: Hernia dissection and defect closure in laparoscopic eTEP are particularly technically challenging and associated with a high surgeon workload. Due to its technical complexity and frequent intraoperative adverse events, laparoscopic eTEP should be adopted within structured training pathways and appropriate case selection.
Glue versus absorbable tacks for mesh fixation in laparoscopic inguinal hernia repair: a systematic review and meta-analysis of postoperative pain and complications.
Costa CPD, Valerio-Alves AP, de Oliveira RGB … +5 more , Gonzaga TMA, de Almeida Porto Maia AB, de Oliveira ZRC, Morriello R, Fernandes MHF
Hernia · 2026 Jul · PMID 42397603 · Full text
PURPOSE: Mesh fixation is not routinely required in most laparoscopic inguinal hernia repairs (LIHR); however, when indicated, the optimal fixation method remains uncertain. This study aimed to compare surgical glue vers...
PURPOSE: Mesh fixation is not routinely required in most laparoscopic inguinal hernia repairs (LIHR); however, when indicated, the optimal fixation method remains uncertain. This study aimed to compare surgical glue versus absorbable tacks (AT) for mesh fixation in LIHR, focusing on postoperative pain and early complications. METHODS: We searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing glue versus AT in elective LIHR. Effect estimates were pooled using random-effects models and expressed as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). The primary outcome was postoperative pain assessed by the visual analogue scale (VAS). Secondary outcomes included complications and operative time. Risk of bias was assessed using the Cochrane RoB 2 tool. Trial sequential analysis (TSA) and prediction intervals (PI) were used to assess robustness. RESULTS: Nine RCTs comprising 1,289 patients were included. Glue fixation was associated with lower early postoperative pain at 7-14 days (MD - 0.77; 95% CI - 1.22 to - 0.33; p < 0.001; I = 83%). However, substantial heterogeneity and wide prediction intervals (- 2.33 to 0.79) indicated variability across settings. TSA suggested evidence of potential effect; however, this finding should be interpreted in the context of substantial heterogeneity. No significant difference was observed beyond 4 weeks, with insufficient cumulative evidence to draw firm conclusions. Glue fixation was associated with lower rates of hematoma and seroma, although the findings were uncertain given the prediction intervals and TSA. Other outcomes were underpowered or inconclusive. CONCLUSION: Glue fixation may be associated with lower early postoperative pain than absorbable tacks after LIHR; however, the available evidence remains heterogeneous and inconclusive for other postoperative outcomes. Further adequately powered randomized trials are required before definitive clinical recommendations can be made.
Robotic-assisted versus laparoscopic esophageal hiatal hernia and anti-reflux surgery: A comprehensive systematic review and meta-analysis.
Xiao X, Zhang C, Li H … +4 more , Chen J, Zhang J, Yu W, Cai X
Hernia · 2026 Jul · PMID 42397587 · Publisher ↗
BACKGROUND: The comparison between robotic-assisted (RS) and laparoscopic anti-reflux surgery (LS) remains clinically relevant due to widespread adoption of robotic techniques without clear evidence of superior outcomes....
BACKGROUND: The comparison between robotic-assisted (RS) and laparoscopic anti-reflux surgery (LS) remains clinically relevant due to widespread adoption of robotic techniques without clear evidence of superior outcomes. This study aims to evaluate both approaches in terms of efficacy, safety, and cost. METHODS: Adhering to PRISMA guidelines, we systematically searched in Medline, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform (2000-2025) for randomized controlled trials (RCTs) and observational studies comparing RS and LS in adults. Pooled analyzes utilized random- or fixed-effects meta-analysis models. Meta-regression, cumulative meta-analysis, and subgroup analyzes were conducted to enhance conclusion precision. Sensitivity analyzes assessed result robustness. RESULTS: The systematic review included 38 studies (5 RCTs and 33 cohort studies) with a pooled population of 550,175 patients. For the primary outcome, no significant difference was observed in overall postoperative complications between RS and LS (RR = 0.85, 95% CI: 0.60-1.20). Among secondary outcomes, RS was associated with longer overall operative times (WMD = 19.81 min, 95% CI: 11.15-28.47 min); however, when only skin-to-skin operative time was analyzed, the difference was not statistically significant (WMD = 11.90 min, 95% CI: -7.75 to 31.55 min). RS demonstrated higher costs (WMD = $2,958.97, 95% CI: $1820.74-4,097.19) versus LS. No statistically significant differences were observed in blood loss, length of stay, intraoperative complications, recurrence, reoperation, or postoperative anti-reflux medication requirements. Cumulative meta-analysis demonstrated stable and consistent differences over time, indicating the early emergence of robust evidence. CONCLUSION: RS showed comparable outcomes to LS in complications, blood loss, recurrence, reoperation, and postoperative medication requirements. RS was associated with higher costs compared to LS. Although overall operative time was longer with RS, subgroup analysis revealed no statistically significant difference in skin-to-skin surgical time between the two approaches. RS had higher costs. Comprehensive evaluations indicate that RS and LS yield analogous outcomes in terms of safety and efficacy for GERD. However, RS is linked to increased financial expenditure.
Hydrodissection in transabdominal preperitoneal repair for indirect inguinal hernia: A randomized controlled trial.
Bu J, Xu D, Hu J … +3 more , Zhang M, Zhang P, Yuan H
Hernia · 2026 Jul · PMID 42397583 · Publisher ↗
OBJECTIVE: Inguinal hernia, a common surgical condition, is preferably managed via transabdominal preperitoneal laparoscopic hernia repair (TAPP) ; however, indirect hernia sac management remains challenging. This random...
OBJECTIVE: Inguinal hernia, a common surgical condition, is preferably managed via transabdominal preperitoneal laparoscopic hernia repair (TAPP) ; however, indirect hernia sac management remains challenging. This randomized controlled trial aimed to assess the efficacy of hydrodissection in reducing seroma incidence and improving perioperative outcomes during TAPP repair for indirect inguinal hernia. METHODS: A prospective, single-blinded randomized controlled trial enrolled 128 male patients, randomized 1:1 to hydrodissection or conventional dissection. The hydrodissection technique involved injecting 10 mL of normal saline into the preperitoneal space on the medial and lateral sides of the internal inguinal ring under laparoscopic guidance, creating a circular fluid distribution to facilitate dissection while avoiding critical structures. Primary outcome was seroma incidence at follow-up; secondary outcomes included operation time and chronic pain. Analyses followed intention-to-treat principles. RESULTS: The median follow-up duration was 14 months. Hydrodissection demonstrated significant reductions in seroma formation (4.69% vs. 15.63%, P = 0.041) and operation time (28.22 ± 4.65 vs. 31.61 ± 6.78 min, P = 0.001) compared with conventional dissection. No significant differences were observed in intraoperative blood loss, hernia sac transection rate, postoperative hospitalization duration, time to first flatus, or total medical costs from surgery to discharge (all P > 0.05). Notably, the cohort reported zero perioperative complications, postoperative adverse events, conversions to open surgery, or unplanned readmissions during follow-up. CONCLUSION: Hydrodissection in TAPP repair safely reduces seroma risk and operative time, offering a promising option for indirect inguinal hernia. Larger multicenter trials are needed to confirm its routine use in standard surgical protocols. TRIAL REGISTRATION: ChiCTR2400080089 at Chictr.org.cn (January 19, 2024).
Comment to: Comparison of polypropylene versus polyester mesh in Lichtenstein inguinal hernia repair with respect to chronic pain and inflammatory changes.
Akalın Ç
Hernia · 2026 Jul · PMID 42397527 · Publisher ↗
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Optimal surgical approach to inguinal hernia repair in adolescents and young adults: is herniotomy alone adequate? a systematic review and meta-analysis.
Sisodiya RS, Acharya H, Agrawal V … +4 more , Yadav SK, Tomar A, Tiwari A, Sharma DB
Hernia · 2026 Jul · PMID 42397477 · Publisher ↗
PURPOSE: The optimal surgical approach for primary inguinal hernias (IH) in adolescents and young adults remains unclear because pediatric and adult treatment strategies often overlap. This systematic review and meta-ana...
PURPOSE: The optimal surgical approach for primary inguinal hernias (IH) in adolescents and young adults remains unclear because pediatric and adult treatment strategies often overlap. This systematic review and meta-analysis (SRMA) aimed to assess whether herniotomy alone (HA) is adequate compared with alternative repair (AR) techniques, using recurrence as the main outcome measure. METHODS: This review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD420261339925). PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched from inception to March 20, 2026, for relevant studies. Studies including patients aged 10-30 years who underwent primary IH repair were included. The outcome was recurrence. A random-effects meta-analysis using log risk ratios (log RR) with 95% confidence intervals (CI) was conducted, and subgroup and sensitivity analyses were performed. RESULTS: Ten studies (n = 42,726), including one randomized controlled trial (RCT) and nine observational studies, were included. HA was not associated with a statistically significant difference in recurrence compared with AR techniques (log RR 0.47, 95% CI - 0.17 to 1.10; p = 0.147) and had moderate heterogeneity (I² = 61%). Sensitivity analysis excluding one influential study showed a higher recurrence rate with HA (log RR 0.73, 95% CI 0.31-1.16; p < 0.001). Subgroup analyses based on age and repair type showed no significant differences. Certainty of evidence was low. CONCLUSION: HA is a reasonable option for selected patients; however, neither HA nor AR techniques demonstrate clear superiority; therefore, an individualized approach is recommended for treating inguinal hernias in adolescents and young adults, incorporating selective reinforcement strategies based on patient and anatomical considerations.
The Posterior Rectus Sheath Incision (PRSI) to allow the repair of Spigelian Hernias by TEP.
Ngo P, Cossa JP, Valenti A … +1 more , Pélissier E
Hernia · 2026 Jul · PMID 42397464 · Publisher ↗
PURPOSE: Spigelian hernias (SHs) occur through the Spigelian fascia which is limited by the lateral border of the rectus sheath medially and the semilunar line of Spiegel laterally. Most SHs occur in the Spigelian belt a...
PURPOSE: Spigelian hernias (SHs) occur through the Spigelian fascia which is limited by the lateral border of the rectus sheath medially and the semilunar line of Spiegel laterally. Most SHs occur in the Spigelian belt above the arcuate line. This anatomical setting makes the access by TEP to the hernia orifice difficult for hernias located above the arcuate line, and it is even considered impossible by some authors. The aim of the study was to describe the technique of posterior rectus sheath incision (PRSI) to allow the TEP repair whatever the SH location and to evaluate long-term results of the technique. METHODS: One 10-11 mm trocar and two 5 mm trocars were introduced in the retrorectus space. Access to the preperitoneal space was achieved by incising the posterior rectus sheath 1 cm medial and parallel to its lateral border. The patch was deployed with 5 cm overlap, straddling half the retrorectus space medially and half the preperitoneal space laterally. Twenty-two cases of SHs in 21 patients were reported. RESULTS: There were 13 males and 8 females of mean age 61.9 years (21-88); 13 hernias were located above the arcuate line. The mean size of the hernia orifice was 2.07 cm (1-5). Long-term evaluation was assessed in the 16 patients who had at least 12 months follow-up. After an average follow-up of 52.8 months (16-108), no recurrences were observed. CONCLUSION: The PRSI technique allows the surgical treatment of SHs by TEP with good results, whatever they are located below or above the arcuate line.
Comment to: Mesh placement and risk of reoperation for recurrence after incisional hernia repair.
Duyan AG, Şener S, Türkoğlu F … +1 more , Çalışır A
Hernia · 2026 Jul · PMID 42397446 · Publisher ↗
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Predicting the need for bowel resection in incarcerated inguinal hernia surgery: the role of clinical indicators.
Pouroushaninia N, Zabihi Mahmoudabadi H, Taraghikhah M … +1 more , Miratashi Yazdi SA
Hernia · 2026 Jul · PMID 42397444 · Publisher ↗
PURPOSE: Incarcerated inguinal hernia is a common surgical emergency, and prompt identification of patients at risk for bowel resection and postoperative complications is essential. This study evaluated clinical and labo...
PURPOSE: Incarcerated inguinal hernia is a common surgical emergency, and prompt identification of patients at risk for bowel resection and postoperative complications is essential. This study evaluated clinical and laboratory predictors for bowel resection in patients treated for incarcerated inguinal hernia. METHODS: In this cohort study, records of 184 patients who underwent surgery for incarcerated inguinal hernia between March 2018 and April 2023 were reviewed. Bowel resection, postoperative complications occurring within two years, and in-hospital mortality were considered in the study. The predictive factors were compared between groups with and without bowel resection. RESULTS: Bowel resection was required in 15 patients (8.2%). Significant predictors of bowel resection included preoperative bowel obstruction, opioid use, higher platelet count, and lower serum albumin (P-value < 0.005). In-hospital complications occurred in 13 patients (7.1%). Of the 184 patients, 118 patients completed the two-year follow-up. Among these, 15 patients (12.6%) experienced at least one long-term complication. Overall mortality was 4.3%. Among inflammatory indices, Systemic Immune-Inflammation Index (SII) (AUC: 0.75), Neutrophil-Lymphocyte Ratio (NLR) (AUC: 0.70), and Platelet-Lymphocyte Ratio (PLR) (AUC: 0.71) demonstrated fair performance in predicting bowel resection. CONCLUSION: Clinical assessment and timely intervention could mitigate the risk of bowel resection in patients presenting with incarcerated inguinal hernia. Knowledge of the aforementioned predictive factors may assist surgeons to prevent postoperative complications in patients with incarcerated inguinal hernia.
Abdominal symmetry index after reconstruction of traumatic lumbar hernia with dual polypropylene mesh: a comparative CT-based study.
Miranda JS, Dantas PP, Koike MK … +8 more , Rocha MS, Faro MP, Murakami AHF, Meira AA, Montero EFS, Birolini CAV, Damous SHB, Utiyama EM
Hernia · 2026 Jun · PMID 42377601 · Full text
PURPOSE: Traumatic lumbar hernia (TLH) is a rare and challenging abdominal wall defect. In these patients, treatment success is usually assessed by recurrence, although persistent postoperative bulging or asymmetry may r...
PURPOSE: Traumatic lumbar hernia (TLH) is a rare and challenging abdominal wall defect. In these patients, treatment success is usually assessed by recurrence, although persistent postoperative bulging or asymmetry may remain clinically relevant even without true failure of repair. This study evaluated the abdominal symmetry index (ASI), defined as a CT-based side-to-side ratio of lateral abdominal wall distance, as an objective morphologic parameter after TLH reconstruction with dual polypropylene mesh. METHODS: A single-center retrospective comparative study was performed at a tertiary academic referral center from 2006 to 2025. The study included 25 consecutive eligible patients with TLH who underwent elective open abdominal wall reconstruction with dual polypropylene mesh and 25 controls without abdominal wall disease. In the TLH group, ASI was assessed on CT before and after surgery; controls underwent a single CT-based assessment. The operative repair consisted of deep preperitoneal/retroperitoneal reinforcement whenever feasible, muscle reapproximation when possible, and preaponeurotic/onlay reinforcement. RESULTS: Sex distribution did not differ significantly between groups. Mean age was 42 +/- 13 years in the hernia group and 37 +/- 13 years in controls, while mean body mass index was 31 +/- 4 and 28 +/- 5 kg/m2, respectively (p = 0.023). Hernia volume was estimated using the ellipsoid formula and had a median value of 443 cm3 (range, 244-1013 cm3). Clinical follow-up was 62 +/- 47 months, and the interval between surgical repair and the latest postoperative CT scan was 687.3 +/- 712.6 days. No recurrence was observed. Before surgery, the measurement on the hernia side was significantly greater than on the contralateral side (185 +/- 24 mm vs. 144 +/- 12 mm; p < 0.0001). After reconstruction, this difference was no longer statistically significant (154 +/- 15 mm vs. 149 +/- 13 mm; p = 0.1022). Mean ASI was 1.29 +/- 0.18 preoperatively, 1.03 +/- 0.07 postoperatively, and 0.99 +/- 0.03 in controls (overall p < 0.0001). Holm-Sidak adjusted pairwise comparisons showed significant differences between preoperative TLH and controls (p = 1.14 × 10^-13) and between preoperative and postoperative TLH (p = 1.64 × 10^-11), whereas postoperative TLH did not differ significantly from controls (p = 0.2142). CONCLUSION: ASI was feasible as an exploratory CT-based morphologic index for postoperative evaluation of TLH repair. Reconstruction with dual polypropylene mesh was associated with substantial improvement in abdominal wall symmetry, with postoperative values approaching those of controls. Further validation, including interobserver reproducibility and correlation with patient-reported outcomes, is required before broader adoption.
Adherence to international guidelines for groin hernia management in a tertiary government hospital: a 1-year retrospective audit.
Tablante KIG, Bragais LCG, Faylona JMV
Hernia · 2026 Jun · PMID 42377585 · Publisher ↗
OBJECTIVE: This study aimed to assess the degree of adherence to key recommendations of the 2023 HerniaSurge International Guidelines for Groin Hernia Management among surgeons performing adult groin hernia repair at a h...
OBJECTIVE: This study aimed to assess the degree of adherence to key recommendations of the 2023 HerniaSurge International Guidelines for Groin Hernia Management among surgeons performing adult groin hernia repair at a high-volume tertiary government training hospital in the Philippines. BACKGROUND: International guidelines for groin hernia management provide evidence-based recommendations to standardize the care of groin hernia cases. Despite dissemination, adherence varies across institutions. Evaluating real-world compliance is essential to identify gaps in implementation. METHODS: A retrospective audit of adult patients who underwent groin hernia repair at the Philippine General Hospital over one year was performed. The primary outcome was guideline adherence rate which was defined as the proportion of cases fulfilling predefined, audit-appropriate operational definitions based solely on ten selected guideline recommendations assessable through routine institutional documentation. RESULTS: A total of 355 patients underwent groin hernia repair during the study period, accounting for 373 hernia units after separating bilateral cases. Use of clinical examination alone for diagnosis of primary inguinal hernias was documented in 203 cases (60.4%), while EHS classification was recorded in 251 cases (70.7%). Appropriate anesthesia was administered in 84.5% of patients, while antibiotic prophylaxis was given in 93.0%. All patients (100%) received recommended postoperative oral analgesics. In contrast, documentation-dependent technical steps such as nerve identification and intraoperative anesthesia infiltration were not recorded in any case, resulting in 0% documented compliance by audit criteria. Among female patients (n = 4), round ligament preservation was documented in one case (25.0%). Compliance patterns varied across training levels and surgical divisions, with higher adherence observed in mesh utilization and prophylaxis than in technical documentation elements. CONCLUSIONS: Adherence to guidelines was high for broadly established practices such as mesh-based repair, antibiotic prophylaxis, and post-operative analgesia, but inconsistent for documentation-sensitive technical recommendations. Findings for intraoperative parameters with 0% documented compliance should be interpreted with caution, as these most likely reflect documentation gaps rather than confirmed non-performance. Gaps in adherence may reflect documentation practices as much as technical deviations. This establishes a baseline for institutional quality improvement and future outcome-linked evaluations.
Opioid-sparing analgesia with clonidine versus fentanyl in inguinal hernia repair: a randomized clinical trial.
de Souza PMF, Morais PC, Santos SF … +1 more , Alberti LR
Hernia · 2026 Jun · PMID 42364024 · Publisher ↗
PURPOSE: To evaluate the efficacy, safety, and cost of clonidine compared with fentanyl as an adjuvant for analgesia in patients undergoing inguinal hernia repair. METHODS: This randomized superiority trial included 138...
PURPOSE: To evaluate the efficacy, safety, and cost of clonidine compared with fentanyl as an adjuvant for analgesia in patients undergoing inguinal hernia repair. METHODS: This randomized superiority trial included 138 patients allocated to fentanyl (GLF) or clonidine (GLC) groups (n = 69 each), undergoing inguinal hernioplasty under local anesthesia with sedation. The primary outcome was postoperative pain intensity assessed by the visual analog scale (VAS). Secondary outcomes included time to first analgesic request, need for rescue analgesia, sedation level (RASS), adverse events, and medication costs. Results were expressed as mean or median differences, or relative risks, with 95% CI. RESULTS: Baseline characteristics were comparable between groups. Clonidine significantly reduced pain intensity compared with fentanyl (median 0 [IQR 0-3] vs. median 2 [IQR 0-4]; Mann-Whitney U = 1864; 95% CI of median difference - 3.00 to - 2.00; p = 0.019). The clonidine group also showed greater sedation (mean difference - 0.6; p = 0.009), longer pain-free time (mean difference 2.0 h; p = 0.001), and lower need for rescue analgesia (34.8% vs. 59.4%; RR 0.59; p = 0.006). Adverse events and costs were similar. The reduced need for rescue analgesia suggests a clinically relevant opioid-sparing effect. CONCLUSION: Clonidine was superior to fentanyl in improving postoperative analgesia, prolonging pain-free duration, and reducing additional analgesic requirements, while maintaining a comparable safety profile and cost.
Comment to Evaluation of usefulness of manual reduction in themanagement of adult acute irreducible abdominal wall hernia.
Pélissier E, Valenti A, Ngo P … +1 more , Cossa JP
Hernia · 2026 Jun · PMID 42363982 · Publisher ↗
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Airway pressure reliably predicts intra-abdominal pressure during laparoscopic surgery.
de Oliveira E Silva PD, de Melo RM, Folgosi JFB … +3 more , Cândido ER, Alves RMC, de Oliveira ÊC
Hernia · 2026 Jun · PMID 42360540 · Full text
BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are life-threatening complications increasingly recognized in the surgical setting, particularly in complex abdominal wall surgery....
BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are life-threatening complications increasingly recognized in the surgical setting, particularly in complex abdominal wall surgery. Bladder pressure monitoring, although the gold standard, is limited intraoperatively due to constraints related to patient positioning, contamination risk, and procedural interruption. We evaluated the correlation between intra-abdominal pressure (IAP) and airway pressure (AWP) during laparoscopic cholecystectomy and the diagnostic accuracy of AWP for detecting intraoperative IAH. METHODS: Prospective observational cross-sectional study in ASA I-II patients undergoing elective laparoscopic cholecystectomy at a single tertiary center, Brazil. Data were collected between 2020 and 2021. Sample size was calculated using the Fleiss method (80% power, two-sided α = 0.05, assumed r = 0.30), requiring a minimum of 80 participants. Pneumoperitoneum was increased incrementally (baseline, 5, 10, 15, 20 mmHg). PIP and PLAT were recorded at each level. A linear mixed-effects model (REML) with patient as random intercept was used as the primary correlation analysis; Pearson correlation is reported as a descriptive secondary measure. ROC analyses were performed. RESULTS: Of 95 patients assessed, 78 completed the study. Both PIP and PLAT correlated significantly with IAP (p < 0.001). Linear mixed-effects model: PIP β = 0.439 cmH₂O/mmHg (95% CI: 0.410-0.468), p < 0.001, ICC = 0.640. PLAT β = 0.134 cmH₂O/mmHg (95% CI: 0.121-0.147), p < 0.001, ICC = 0.936. Pearson r (descriptive): PIP r = 0.670 (95% CI: 0.612-0.722); PLAT r = 0.253 (95% CI: 0.157-0.343). PIP increased by 6.99 cmH₂O at IAP 15 mmHg and 8.06 cmH₂O at IAP 20 mmHg. ROC analysis showed excellent diagnostic accuracy for PIP (AUC 0.905, 95% CI: 0.868-0.940), with an optimal cutoff of 24 cmH₂O (84.6% sensitivity, 87.2% specificity). PLAT showed poor diagnostic accuracy (AUC 0.695, 95% CI: 0.662-0.737) and is not a reliable clinical surrogate for IAP. CONCLUSION: PIP strongly correlates with IAP and accurately detects intraoperative IAH. PLAT is not recommended as a standalone diagnostic surrogate for IAP. Airway pressure monitoring may serve as a practical, real-time screening tool during abdominal surgery, with particular promise in complex abdominal wall reconstruction.
Postoperative abdominal bulging after eTEP rives-stoppa repair despite posterior rectus sheath closure: a CT-based ellipse 9 study.
Rossi MM, Montechiari DA, Portela I … +4 more , Flores SA, Rossini A, Obeide L, Signorini FJ
Hernia · 2026 Jun · PMID 42334631 · Publisher ↗
PURPOSE: Postoperative bulging has been reported after enhanced-view totally extraperitoneal (eTEP) repair, but its underlying mechanisms remain unclear. This study aimed to objectively evaluate postoperative abdominal w...
PURPOSE: Postoperative bulging has been reported after enhanced-view totally extraperitoneal (eTEP) repair, but its underlying mechanisms remain unclear. This study aimed to objectively evaluate postoperative abdominal wall contour changes after eTEP repair with systematic posterior rectus sheath (PRS) closure and to identify factors associated with postoperative bulging using the Ellipse 9 tool. METHODS: A retrospective observational study was conducted including patients who underwent eTEP repair with systematic posterior rectus sheath closure for midline hernias with rectus diastasis between 2019 and 2024 and had available preoperative and postoperative computed tomography scans. Abdominal morphometric parameters were analyzed using the Ellipse 9 tool at standardized anatomical levels. Rectus muscle density was assessed. Patients were classified into bulging and non-bulging groups. Preoperative and postoperative measurements were compared within and between groups. RESULTS: Thirty-three patients were included: 24 patients (73%) did not develop postoperative bulging (non-bulging group), whereas 9 patients (27%) developed bulging (bulging group). In the overall cohort, a significant bilateral reduction in rectus muscle density was observed (p<0.001), with no relevant modifications in global abdominal contour. The non-bulging group showed decreased muscle density (right: p=0.036; left: p=0.012) without significant geometric contour changes. In contrast, the bulging group demonstrated significant increases in abdominal dimensions (p≤0.002) and greater reductions in eccentricity (p<0.001), indicating a rounder contour, along with a predominant reduction in right-sided rectus muscle density (p=0.036). CONCLUSION: Postoperative bulging may occur despite systematic PRS closure, supporting a multifactorial origin. Rectus atrophy was insufficient as a sole mechanism, suggesting additional contributions from surgical and functional factors. Structured rehabilitation may improve postoperative outcomes.
Abdominal binders versus semi-rigid corsets after open ventral hernia repair: early postoperative tolerance and patient preference in a randomized cross-over study.
Mitura K, Pajer M, Kacprzak L … +6 more , Niecikowski P, Wojcik M, Mitura L, Sawicka M, Witowska I, Kisielewski K
Hernia · 2026 Jun · PMID 42334630 · Full text
BACKGROUND: The use of abdominal supports after ventral hernia repair remains common practice despite inconsistent evidence and lack of clear recommendations. Concerns persist that more rigid devices may be poorly tolera...
BACKGROUND: The use of abdominal supports after ventral hernia repair remains common practice despite inconsistent evidence and lack of clear recommendations. Concerns persist that more rigid devices may be poorly tolerated in the early postoperative period. AIM: To compare early postoperative patient-reported health state, functional outcomes, global preference, and willingness to recommend an elastic abdominal binder and a semi-rigid corset. METHODS: In this prospective randomized within-subject cross-over study, 23 patients following open sublay repair of large ventral hernias were sequentially fitted with an elastic abdominal binder and a semi-rigid corset on postoperative day 2-3. Each device was worn for approximately three hours during routine postoperative activities. Patient-reported outcomes were assessed using VAS and EQ-5D-5 L questionnaires. Global preference and willingness to recommend each device were recorded. RESULTS: VAS scores were comparable between devices (p = 0.36), indicating no deterioration in perceived health state with corset use. No EQ-5D-5 L domain was rated worse with the corset. Significant improvements were observed for usual activities and anxiety/depression. A majority of patients preferred the corset (69.6%), and significantly more patients recommended it compared to the binder (95.7% vs. 65.2%, p = 0.039). CONCLUSIONS: Semi-rigid corsets were not associated with worse early postoperative tolerance and were more frequently preferred and recommended by patients. Early tolerance of semi-rigid supports may influence patient acceptance of postoperative abdominal support strategies, although long-term adherence was not assessed in the present study. These findings challenge the assumption that more rigid supports are poorly tolerated and support considering semi-rigid corsets as a viable option after open ventral hernia repair.
Frailty in a low-risk elective setting: a quality improvement study at Shouldice Hospital.
Paasch C, Svendrovski A, Usher J … +1 more , Mainprize M
Hernia · 2026 Jun · PMID 42319539 · Publisher ↗
PURPOSE: This study aims to evaluate the impact of frailty on postoperative outcomes after Shouldice primary inguinal hernia Repair (SPIHR) as a quality control measure in a highly standardized elective setting. METHODS:...
PURPOSE: This study aims to evaluate the impact of frailty on postoperative outcomes after Shouldice primary inguinal hernia Repair (SPIHR) as a quality control measure in a highly standardized elective setting. METHODS: This quality improvement study analyzed data from an ongoing prospective PROM program including patients undergoing primary unilateral or bilateral Shouldice inguinal hernia Repair. Frailty was assessed using the 5-item modified Frailty Index (mFI-5). Postoperative complications were identified via 30-40-day questionnaires and clinically verified when reported. Outcomes were compared between frail and non-frail patients using univariate analyses and multivariable logistic regression adjusted for relevant covariates. Data analysis was performed between December 2025 and January 2026. RESULTS: A total of 1,300 patients undergoing primary Shouldice inguinal hernia Repair were included (median age 64 years; 94.6% male). Overall, 29.7% of patients were classified as frail (mFI-5 ≥ 1). In univariate analyses, frail patients were older and had a higher body mass index and a greater comorbidity burden compared with non-frail patients. Frail patients also presented with larger hernia sizes for both first and second hernias. Postoperative complications were infrequent and did not differ significantly between frail and non-frail patients. In logistic regression analyses, frailty status was not independently associated with postoperative complications in either unadjusted or adjusted models. CONCLUSION: Frailty was present in nearly one-third of patients undergoing Shouldice primary inguinal hernia Repair. Short-term postoperative complication rates were comparable between frail and non-frail patients, suggesting that primary Shouldice Repair is feasible in frail patients within a standardized elective setting.
Navigating the landscape of novel meshes: comprehensive review of physicomechanical categorization of mesh for hernia repair.
Adams AJ, Smith JE, Taritsa IC … +7 more , Stigliano M, Li K, Rao A, Lee D, Foppiani JA, Lin SJ, Lee BT
Hernia · 2026 Jun · PMID 42319532 · Publisher ↗
INTRODUCTION: In the vast landscape of commercially available and newly emerging meshes for abdominal wall repair, surgeons must understand the biomechanical advantages of current synthetic and biologic mesh materials. M...
INTRODUCTION: In the vast landscape of commercially available and newly emerging meshes for abdominal wall repair, surgeons must understand the biomechanical advantages of current synthetic and biologic mesh materials. METHODS: A librarian conducted a literature search on PubMed, Web of Science, and CENTRAL, following PRISMA guidelines, to identify relevant articles published from January 2010 to January 2024. Two independent reviewers performed all screening steps. An exploratory quantitative synthesis was performed using generalized linear models with a Gamma distribution and log link. RESULTS: Our study identified 30 studies describing the physico-mechanical properties of 67 unique meshes. The majority of novel mesh materials were synthetic (85.07%, n = 57), compared to biologic (14.92%, n = 10). Pore sizes ranged from 0.10 mm² to 5.0 mm². They were subcategorized as small (0.01-0.28 mm), medium (0.28-0.79 mm), large (0.79-3.14 mm), and very large (> 3.14 mm), based on previous studies, which found these denominations to be more informative than the terms "microporous" and "macroporous." Suture retention strength, tensile strength, and burst strength were compared. Synthetic medium- to large-pore mesh performed sufficiently to withstand intra-abdominal pressures in terms of burst strength (>50 N/cm), tensile strength (>50 N/cm), and suture retention (>20 N) compared to small-pore synthetic mesh. Among biologic meshes, cross-linked biologic meshes demonstrated strong tensile and suture-retention strengths; however, data on other biomechanical properties were lacking. CONCLUSIONS: These results demonstrate the need to understand how the structural characteristics of each fully mesh design, such as fabrication technique and pore size, in conjunction with mechanical properties such as tensile strength, burst strength, and suture retention strength, influence clinical outcomes.
Single-incision laparoscopic preperitoneal repair: novel approach to umbilical hernia surgery (with video).
Yu W, Ye Z, Lin Y … +4 more , Lu X, Du Y, Huang M, Zhang Y
Hernia · 2026 Jun · PMID 42319521 · Publisher ↗
INTRODUCTION: Umbilical hernia is a frequently encountered surgical condition. Its optimal repair method remains debatable. This retrospective study presents a novel technique for umbilical hernia repair, the single-inci...
INTRODUCTION: Umbilical hernia is a frequently encountered surgical condition. Its optimal repair method remains debatable. This retrospective study presents a novel technique for umbilical hernia repair, the single-incision laparoscopic (SIL) preperitoneal repair, and compares it with the currently most widely adopted technique, intraperitoneal onlay mesh (IPOM). METHODS: We reviewed cases of umbilical hernias (> 1 cm) treated with either SIL or IPOM at our center, detailing the SIL procedure and comparing demographics, complications, costs, and outcomes. RESULTS: In the study of 107 umbilical hernia patients, 61 underwent SIL repair and 46 underwent IPOM repair. Both groups had similar baseline characteristics. SIL had a shorter median operating time (57 vs. 64 min, p = 0.030) and a shorter postoperative stay (2 vs. 2.7 days, p = 0.019). SIL also had lower hospitalization costs (1709.7 ± 177.3 vs. (2545.4 ± 528.0 EUR, p < 0.001). No recurrences or mesh infections were observed during follow-up. CONCLUSION: Compared to the current laparoscopic IPOM plus standard, SIL preperitoneal repair demonstrates comparable safety and represents a feasible and reproducible minimally invasive alternative within the extraperitoneal spectrum. While this study observed shorter operative time and lower institutional costs, these findings should be interpreted with caution. No recurrences were observed during the short-term follow-up. This technique can be standardized, but further comparative studies are required to define its role relative to other established repairs.
Correction to: Diastasis recti in male patients: a literature review and proposed management.
Axelsen KH, Diasso P, Christoffersen MW … +1 more , Henriksen NA
Hernia · 2026 Jun · PMID 42319494 · Publisher ↗
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