Hernia

OviTex® mesh is a reinforced tissue matrix (RTM) that combines biologic and synthetic components, aiming to reduce inflammatory response while providing durable abdominal wall support. Comparative analyses indicate it performs similarly to synthetic mesh regarding hernia recurrence and surgical site infection rates, and may be preferable in patients with increased risk factors or prior mesh infection. This systematic review and meta-analysis evaluated the efficacy and safety profile of OviTex, particularly in patients undergoing ventral hernia repair (VHR). Following PRISMA guidelines, we searched PubMed, Embase, Scopus, and ClinicalTrials.gov from inception to September 2025. Studies comparing the use of OviTex in VHR with synthetic or other biologic meshes were included. The primary endpoint was recurrence rates. Secondary outcomes were surgical site occurrences (SSO) and hospital length of stay (LOS). Statistical analysis was performed with Review Manager 5.4 using a random-effects model. From 202 records, 9 met our inclusion criteria, to which 4 were included in our final pooled analysis. These studies encompassed 534 patients (OviTex n = 194 [36.3

It remains controversial whether minimally invasive surgery (MIS) is superior to open surgery for inguinal hernia repair. MIS is growing in popularity, but open surgery remains more common. Consensus remains elusive even though numerous studies have been published about the topic. A new method for sensitivity analysis, the Robustness of Inferences to Replacement (RIR), can summarize the complex body of literature and evaluate the strength of the published findings to better support surgical decision-making. This study applied the RIR to the available evidence about this topic. We reviewed studies from published meta-analyses that compared MIS versus open surgery for elective, unilateral inguinal hernia repair and calculated the RIR for each study and for the cumulative data. The RIR indicates how many patients in a published study must be replaced from a null-hypothesis population for the published result to be overturned. Higher RIRs indicate more robust conclusions. The literature review identified 40 randomized trials for inclusion. In the cumulative analysis, MIS had higher incidence of hernia recurrence (RIR 21), lower incidence of chronic pain (RIR 276), and lower immediate post-operative pain (RIR 1,282). The evidence supporting MIS for decreased post-operative pain and chronic pain is substantially stronger than the evidence supporting open surgery for decreased hernia recurrence. However, there is likely not a clearly superior method for all patients. The findings demonstrate how the RIR can support better surgical decision-making by helping surgeons to interpret a large and complex body of published literature.

Symptom duration ≥ 72 h increases bowel resection risk in incarcerated obturator hernia, but onset is often imprecise, especially in patients without pain. We investigated whether hernia-sac computed tomography (CT) attenuation improves prediction beyond symptom duration. In this single-center retrospective cohort study of patients treated between 2006 and 2023, onset was determined from electronic medical records using the best available clinical information. On non-contrast CT, mean hernia-sac attenuation in Hounsfield units (HU) was measured using a circular region of interest on the slice with the largest hernia-sac area. Firth logistic regression was used with bowel resection as primary outcome. In patients with HU available, incremental value of ≥ 20 HU beyond symptom duration ≥ 72 h was tested with likelihood ratios and changes in the area under the receiver operating characteristic curve (AUC); patients without pain were explored separately. Among 39 patients (median age 88y, median body mass index 16.3 kg/m²), symptom duration ≥ 72 h strongly associated with bowel resection (odds ratio 18.6, 95

Complex incisional hernias after major upper abdominal surgery are technically challenging because of altered anatomical planes, multiple fascial defects, and expected adhesions. Robotic enhanced-view totally extraperitoneal repair with transversus abdominis release may provide a minimally invasive option for selected patients by enabling retromuscular dissection, fascial closure, and wide extraperitoneal mesh reinforcement while limiting intraperitoneal manipulation. This video vignette presents an 84-year-old man with multiple incisional hernia defects along a previous Mercedes incision after liver transplantation and a concomitant left direct inguinal hernia. Preoperative imaging demonstrated a wide subxiphoid abdominal wall defect and a fat-containing left inguinal hernia. A robotic eTEP-TAR approach was performed. Bilateral retromuscular dissection was completed, the inguinal and incisional hernia contents were reduced, and bilateral transversus abdominis release was performed to facilitate medial fascial advancement and lateral extension of the working space. The fascial and peritoneal defects were closed intracorporeally, and wide mesh reinforcement was achieved using a 30 × 30 cm polypropylene mesh, with additional meshes placed for the inguinal and lower quadrant defects. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. At postoperative day 7 follow-up, he had no complaints, and the wounds were clean. This case demonstrates the feasibility of robotic eTEP-TAR abdominal wall reconstruction with concomitant inguinal hernia repair in a selected post-transplant patient with complex abdominal wall defects.

Laparoscopic intraperitoneal onlay mesh repair with a combination of hernial defect closure (IPOM plus) is an effective and common surgical procedure performed in patients with incisional ventral hernia. The introduction of extended-view totally extraperitoneal Rives-Stoppa procedure (eTEP RS) has sparked debate among surgeons regarding the optimal technique for ventral hernia repair. Our randomized clinical study aims to compare IPOM plus and eTEP RS techniques in patients with midline incisional ventral hernias. This is a prospective, single-center, single-blind randomized clinical trial, that was conducted at Moscow City Hospital №1 (Pirogov Russian National Research Medical University’s Faculty Clinic) from February 2023 to April 2025. Patients were randomly allocated in a 1:1 ratio to either the eTEP RS group (Group I) or the IPOM plus group (Group II). The primary endpoint of this study was the level of pain on the first postoperative day, measured using the numerical pain scale (NRS-11). The secondary endpoints included the level of pain after 6 ± 1 h, on the 7 (± 1), 30 (± 3) and 100 (± 5) days after surgery, length of stay, postoperative analgesic consumption, short-term complications rate and the presence of chronic pain. 72 patients were allocated equally to eTEP RS (n = 36) and IPOM plus (n = 36) groups. The average pain score on the first postoperative day in the IPOM plus group was significantly higher compared with eTEP RS group (p < 0.001). Comparison of median NRS-11 scores showed significantly lower pain in the eTEP RS group at 6 ± 1 h (p < 0.001), on 7 ± 1 days (p < 0.001), and 30 ± 3 days (p = 0.005). Chronic pain was observed more often in patients who underwent IPOM plus (38.9

Recurrent inguinal hernia remains a significant challenge in abdominal wall surgery despite advances in mesh-based repair techniques and minimally invasive approaches. Although pelvic skeletal morphology has been implicated in inguinal hernia development, its association with recurrent disease remains incompletely understood. This study aimed to evaluate computed tomography (CT)-derived pelvic morphometric parameters and investigate their potential value in preoperative recurrence risk assessment. This retrospective study included 251 male patients with preoperative abdominal CT examinations and complete clinical records who underwent elective inguinal hernia repair at a tertiary referral center. After applying the predefined eligibility criteria, 188 patients with unilateral inguinal hernias constituted the primary study cohort, including 162 primary and 26 recurrent unilateral hernias. The Radoievitch angle and Ami’s line were measured independently by two blinded radiology residents using a standardized CT-based pelvic morphometric measurement protocol, and the mean values were used for analysis. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between pelvic morphometric parameters and recurrent inguinal hernia. Patients with recurrent unilateral inguinal hernias demonstrated significantly greater affected-side Ami’s line measurements (8.27 ± 0.63 vs. 7.90 ± 0.71 cm, p = 0.014) and larger Radoievitch angles (40.68 ± 4.02° vs. 38.80 ± 3.68°, p = 0.018) than patients with primary unilateral hernias. Both the Radoievitch angle (OR 1.14, 95

This population-based study aimed to characterize the distribution of inter-rectus distance (IRD) and its upper range in adult women using standardized multisite ultrasound measurements and a percentile-based interpretive framework. Data was driven from the Finnish Women’s Health Study (WENDY, 2020–2023), comprising women assigned female at birth with a mean age of 35 years (age range 33–37 years, SD 0,6). Women less than six months postpartum, exclusively breastfeeding, or with prior midline abdominal surgery or hernia repair involving a midline incision or abdominoplasty were excluded. Inter-recti distance was measured at six predefined locations along the linea alba in the supine, knee-flexed resting position using ultrasound. For the analysis, the maximal IRD of each examinee across all sites was used. A total of 1,840 women with naturally occurring anatomy were examined. At the standard site 3 cm above the umbilicus, the mean IRD was 2.37 cm (SD 1.19 cm; range 0.35–9.86 cm). Nulliparous women had a lower mean IRD (1.52 cm, SD 0.70 cm; 0.35–4.37 cm, n = 539) than parous women (2.71 cm, SD 1.18 cm; 0.46–9.86 cm, n = 1,301). The cohort’s 80th percentile for IRD was 3.24 cm. Based on maximal IRD, 38.5

Over the past three decades, the surgical management of inguinal hernia has undergone considerable advancement. In the setting of open inguinal hernia repair, the Liechtenstein tension-free technique continues to be regarded as the standard treatment; parallelly the Trabucco technique has attracted attention due to its sutureless mesh fixation. This study presents a multicenter evaluation of the Trabucco repair, with an emphasis on hernia recurrence, postoperative complications, chronic pain, and cosmetic outcomes over a five-year follow-up period. Multicenter retrospective study using a prospectively maintained database from March 2019 to December 2024. The study included all patients who underwent Trabucco repair for monolateral, uncomplicated groin hernia classified as M1-2 or L1-2. Exclusion criteria comprised patients with L3/M3 groin hernias, those undergoing surgery for hernia recurrence, and cases lost to follow-up. The primary outcome was hernia recurrence determined on both clinical and imaging confirmation. Overall, 1,846 patients completed 1-year follow-up and were included in the analysis; follow-up compliance was 92

Reducing the use of perioperative opioids in outpatient ventral hernia repair (VHR) has potential to limit negative side effects and the risk of opioid dependence. The effect of operative approach on opioid prescription in VHR is incompletely understood. Our objective is to compare rates of opioid prescription among robotic-assisted (RVHR), laparoscopic (LVHR), and open ventral hernia repair (OVHR). A retrospective cohort study was conducted using a United States insurance claims database of outpatient VHR from 2018 to 2022. The cohort was divided into two groups: hernias coded as ventral or incisional and those coded as umbilical, epigastric, or spigelian. Opioid prescription fills were assessed at postoperative day (POD)0–14, POD15-30, and POD90-180. Surgical approaches were compared after propensity score matching (PSM) using logistic regression. 22,899 incisional/ventral hernia repairs (9.4

Ventral hernia repairs (VHR) are common surgical procedures, yet patients remain at risk for serious postoperative complications, including hospital readmission secondary to venous thromboembolism (VTE). While minimally invasive surgical (MIS) approaches have shown benefits in reducing other complications and hospital length of stay (LOS), their impact on VTE-related readmissions has been less extensively studied. This retrospective cohort study utilized the Nationwide Readmissions Database (NRD) from 2016 to 2022 to identify adult patients undergoing VHR, categorizing them into open or MIS approaches. The primary outcome was non-elective 30-day readmission for VTE. Secondary outcomes included LOS, in-hospital mortality at readmission, and total inpatient hospitalization costs. To minimize selection bias and balance baseline characteristics between open and MIS approaches, a propensity score-matched (PSM) analysis was performed, with specific subgroup analyses for hernia type and surgical complexity. Initially, 834,298 patients were identified (Open: 74.5

Emergency surgery for incarcerated groin hernias (IGH) in older adults is associated with high morbidity. While age is a known factor, the impact of physiological reserve and functional frailty on outcomes remains poorly quantified. To evaluate the impact of comorbidity burden and frailty on postoperative outcomes in older adults (≥65 years) undergoing emergency IGH repair, compared to a younger cohort (<65 years). This retrospective cohort study included 135 consecutive patients (older adults, n=62; younger patients, n=73). Baseline risk was assessed using the Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS). Primary outcome was 30-day mortality; secondary outcomes included complications and ICU admission. Older adults had significantly higher physiological and functional risk profiles compared to younger patients (Mean CCI: 4.6±1.3 vs. 1.7±1.1, p<0.001; Mean CFS:4.9±1.2 vs. 2.4±0.8, p<0.001). Intestinal obstruction was more prevalent in older adults(64.5

Recurrence rates and chronic postoperative inguinal pain after groin hernia repair have remained largely unchanged over the past three decades, irrespective of surgical approach. While hernia defect closure is incorporated in some open repair techniques, closure of the internal inguinal ring during endoscopic repair has not been adopted, primarily due to concerns regarding nerve entrapment. New robotic platforms provide enhanced visualization and instrument articulation, potentially enabling safe internal ring suture closure. This prospective observational study included 43 patients with large groin hernias who underwent robotic transabdominal preperitoneal (rTAPP) inguinal hernia repair with partial suture closure of the internal inguinal ring as an adjunct to mesh implantation. Patient demographics, operative details, perioperative complications, postoperative pain, and incidence of neuropathic pain were analyzed. Quality of life was assessed using the EuraHS Quality of Life (QoL) score. A total of 56 hernia sites were repaired (26 unilateral, 30 bilateral). 66

Laparoscopic percutaneous extraperitoneal closure (LPEC) is an established procedure for pediatric inguinal hernia repair. In adults, however, its application is technically more demanding because of a thicker abdominal wall, greater tissue resistance, and a deeper ligation plane. Based on our standardized pediatric LPEC technique, we describe technical refinements for adult indirect inguinal hernias and examine an important cautionary finding related to patient selection. Among adults with suspected indirect inguinal hernia treated between 2023 and 2025, 20 patients who underwent LPEC were evaluated. For adult cases, we incorporated several technical refinements, including double ligation, puncture-site enlargement, tension reduction during ligation, and needle-route straightening. The procedure was completed in selected adults, including those with a high body mass index and greater abdominal wall thickness. Recurrence occurred in two patients, both of whom had preoperative bowel protrusion. This finding suggests that bowel protrusion should be regarded as an important cautionary feature when considering the indication for adult LPEC. Standardized pediatric LPEC may be adapted for selected adults when appropriate technical refinements are applied. However, cases with preoperative bowel protrusion require particularly careful judgment when determining indication.

Prospective data evaluating patient-reported outcomes after Peritoneal Flap Hernioplasty (PFH) are scarce. We aimed to prospectively evaluate quality of life (QoL) using the EuraHS-QoL instrument in complex ventral hernia patients undergoing PFH and determine if the postoperative abdominal bulge associated with this bridge technique impacts clinical success from the patient’s perspective. A prospective observational cohort study was conducted at a single tertiary care centre from June 2023 to June 2025. Consecutive patients undergoing PFH with or without component separation for large ventral hernias were enrolled. Quality of life (QoL) was assessed using a Hindi translation of the validated EuraHS-QoL score preoperatively and at 3 months postoperatively. Of the 61 enrolled patients, one was excluded due to an iatrogenic bowel injury, resulting in population of 60. Safety outcomes were evaluated for all 61 patients, whereas efficacy outcomes were assessed for the remaining 60. The mean EuraHS-QoL score demonstrated significant improvement, declining from 43.67 ± 4.70 preoperatively to 14.40 ± 3.73 at the 3-month follow-up. The mean defect width was 9.38 ± 4.75 cm, with an average operative duration of 249.92 ± 99.69 min. Minor morbidity occurred in 19.7

Achieving tension-free midline fascial closure in complex midline incisional hernias frequently necessitates posterior component separation with transversus abdominis release (TAR). Preoperative administration of botulinum toxin A (BTA) has been proposed as an adjunctive strategy to induce temporary chemical relaxation of the lateral abdominal wall, potentially facilitating primary fascial closure and reducing the need for TAR. This study evaluates the impact of BTA within the BRIDGE-HERNIA protocol on surgical management of patients with complex incisional hernia. This retrospective multicenter observational cohort study conducted across three centers included 42 patients with complex midline incisional hernias and transverse defect width ≥ 10 cm. All patients underwent ultrasound-guided preoperative injections of BTA into the lateral abdominal wall muscles. Computed tomography (CT) scans obtained before and after BTA administration were used to assess changes in transverse defect width and lateral muscle elongation. Surgical repair was tailored intraoperatively based on fascial tension, with Rives–Stoppa repair performed when feasible and TAR reserved for cases with persistent tension. After BTA administration, 33 of 42 patients (78.6

Complex W3 ventral hernias with loss of domain (LOD) pose challenges in abdominal wall reconstruction due to pathological retraction and increased stiffness of the lateral abdominal muscles. Preoperative botulinum toxin type A (BTA) facilitates tension-free closure, but objective assessment remains poorly standardized. Two-dimensional shear wave elastography (2D-SWE) enables non-invasive quantification of tissue stiffness. This prospective study included 20 healthy volunteers (control) and 6 patients with EHS W3 ventral hernias. Reference stiffness values for external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were established using 2D-SWE. Patients underwent stiffness measurements before BTA, one month after BTA, and at 1,3,6,12 months postoperatively. All underwent Rives–Stoppa hernioplasty. Control reference values were 13.38 kPa (EO), 13.61 kPa (IO), and 15.23 kPa (TrA). Before BTA, hernia patients showed elevated EO (24.2 ± 4.8) and IO (20.6 ± 2.3) stiffness (p < 0.001), while TrA stiffness (17.8 ± 3.6) did not differ from controls (p = 0.09). One month after BTA, stiffness decreased (EO: 14.3 ± 2.4, p = 0.21 vs. controls; IO: 10.2 ± 1.8, p < 0.001; TrA: 9.6 ± 1.2, p < 0.001). Postoperative stiffness progressively declined through 12 months (EO: 7.8 ± 0.9; IO: 7.4 ± 0.8; TrA: 7.3 ± 0.4). Primary fascial closure was achieved in all patients without additional component separation. 2D-SWE provides objective assessment of BTA-induced muscular relaxation and postoperative remodeling. Established control reference values enable reliable stratification of pathological stiffness and monitoring of therapeutic response, supporting personalized surgical planning.

Evaluate the impact of sugammadex on gastrointestinal recovery following complex AWR. This single-center, double-blinded, randomized controlled trial randomized 184 patients undergoing open retromuscular AWR to receive either sugammadex or neostigmine/glycopyrrolate for neuromuscular blockade reversal per drug packaging protocol. The primary outcome was time to gastrointestinal recovery (GI-2), defined as tolerance of solid food and first bowel movement and univariate and multivariate analysis was used to compare sugammadex and neostigmine/glycopyrrolate cohorts. Secondary outcomes included incidence of POI, hospital length of stay, and opioid consumption among our two cohorts. The final analysis included 177 patients (88 sugammadex, 89 neostigmine/glycopyrrolate). Median time to GI-2 recovery was similar between groups (89 vs. 87 h, Wilcoxon rank-sum p = 0.637). No significant differences were observed in POI incidence (21

Closed-incision negative-pressure wound therapy (ciNPWT) has been shown to reduce complications in high-risk wounds, but there is still no consensus in literature to whether it is effective when compared to standard wound dressing (SWD). Therefore, we aimed to perform a systematic review and meta-analysis to assess the ongoing uncertainty regarding its clinical benefits. PubMed, Embase and Web of Sciences were systematically searched from inception to November 2025 for both observational and randomized studies comparing ciNPWT with SWD for patients submitted to abdominal wall reconstruction (AWR). A DerSimonian-Laird random-effect model and heterogeneity (assessed with Cochran’s Q test and I² statistics) were performed using R software (version 4.4.0). 16 studies comprising 1,859 patients which underwent AWR, of whom 50