Superficial wound morbidity frequently arises within the subcutaneous compartment, yet abdominal closure research usually treats this layer as an undifferentiated interval between fascia and skin. We examined whether approximation or drainage improves outcomes, whether local phenotype helps explain inconsistent effects, and which indirect mechanisms merit testing, including their relevance to ventral and incisional hernia surgery. We conducted a structured critical review using database searches through 4 September 2026. Reports were selected once against anatomical and evidence-stream criteria. Direct abdominal studies and labelled mixed non-caesarean syntheses were separated from prognostic morphometry and other indirect evidence; no de novo meta-analysis was performed. The principal non-caesarean Cochrane synthesis included eight randomised trials, three involving nonabdominal wounds; six contributed data (815 participants), all at high risk of bias. Approximation showed no clear effect on SSI or superficial dehiscence, and drain evidence remained discordant across heterogeneous protocols. Clinically treated seroma, haematoma, superficial separation, and skin or fat necrosis were inconsistently reported, while SSI definitions and follow-up varied. Hernia-specific drain and quilting studies directly examined superficial-space management during abdominal-wall reconstruction, but did not establish a phenotype-specific treatment effect or, for drainage, isolate a purely subcutaneous intervention. Local measurements were prognostic, but we identified no eligible study that formally tested a treatment-by-phenotype interaction. Current evidence supports neither universal approximation nor universal drainage. Future trials should prioritise layer-specific outcomes, define the anatomical target, report the complete intervention protocol, and prespecify treatment-by-phenotype interactions. The proposed framework remains a research design, not a clinical algorithm.
Lateral incisional hernias remain technically challenging, and evidence supporting minimally invasive extraperitoneal reconstruction is scarce. We describe a tailored minimally invasive preperitoneal strategy avoiding posterior component separation and evaluate its early multicenter outcomes. A retrospective multicenter cohort study included consecutive patients undergoing minimally invasive preperitoneal reconstruction for lateral incisional hernias between April 2024 and May 2026 at three specialized abdominal wall centers. Surgical access was individualized according to the condition of the linea alba and reconstructive requirements using direct Pe-TEP or Carolina's crossover. The primary outcome was technical success without posterior component separation. Secondary outcomes included perioperative variables, surgical site occurrences (SSOs), length of stay, readmissions, reoperations, chronic pain, and recurrence. Forty-seven patients underwent minimally invasive lateral preperitoneal reconstruction. Carolina's crossover was performed in 24 (51.1
Consensus guidelines for the management of adolescent inguinal hernia repair remain lacking. While high ligation remains common among pediatric surgeons, mesh-based floor reinforcement is selectively used by some surgeons for adolescents with larger or more complex hernias. Consequently, significant variability exists in the surgical management of adolescents with inguinal hernias. In this study, we describe an institutional algorithm that utilizes an individualized approach to adolescent inguinal hernia repair. We conducted a retrospective analysis of adolescents aged 12–18 years who underwent laparoscopic inguinal hernia repair (LIHR) or robotic-assisted transabdominal preperitoneal (rTAPP) inguinal hernia repair with mesh over a four-year period, following a standardized decision-making algorithm. If on initial diagnostic laparoscopy there was a processus vaginalis > 2 cm, long hernia sac with scrotal component, or direct component, we proceeded with rTAPP. Otherwise, LIHR was performed. 44 adolescents underwent inguinal hernia repair using this algorithm. For LIHR, median (IQR) operative time, age, and weight were 20 min (13–38), 15 years (14–16), and 59 kg (53–66), respectively. For rTAPP, these were 115 min (105–133), 16 years (15–17), and 67 kg (58–77), respectively. Only operative time was statistically significant between the two cohorts. There were neither conversions to open, postoperative admissions, nor instances of recurrence to date. Our institution successfully implemented a tailored algorithm for adolescent hernia repair based on age and hernia characteristics. Mesh was well tolerated without additional morbidity and no recurrences during available follow-up. This highlights the safety, effectiveness, and relevance of a customized algorithm in this unique population.
Defect width informs surgical planning in ventral hernia repair (VHR). We evaluated its association with operative approach, mesh plane selection, and perioperative resource utilization. Retrospective cross-sectional analysis of the Abdominal Core Health Quality Collaborative (ACHQC) multicenter registry (2012–2023) including adults undergoing VHR. Transverse defect width, grouped using adapted European Hernia Society width groups (W1 < 4 cm; W2 4–10 cm; W3 > 10 cm), was the primary exposure. Primary outcomes were operative approach and mesh plane; secondary outcomes were prolonged operative time (> 240 min) and length of stay (LOS). Approach models adjusted for patient and hernia factors; operative-time models included width and approach or mesh plane. Among 53,544 repairs, 63.3
Recurrent inguinal hernia remains a common challenge in abdominal wall surgery. Current guidelines from the European Hernia Society recommend repairing recurrent inguinal hernias through the previously unoperated anatomical plane (“switch the plane” strategy), supporting a posterior repair after failed anterior repair. Although this strategy is widely adopted in clinical practice, the evidence supporting its superiority remains limited. This systematic review and meta-analysis aimed to evaluate surgical outcomes after recurrent inguinal hernia repair according to the anatomical plane of the index and subsequent repair. A systematic review and meta-analysis were conducted according to PRISMA guidelines. Databases including PubMed, Embase, Web of Science, Cochrane Library, and LILACS were searched for studies evaluating surgical repair of recurrent unilateral inguinal hernia. Comparative studies assessing posterior versus anterior repair were included for pooled comparative meta-analysis. Outcomes included hernia recurrence, chronic postoperative inguinal pain, surgical site infection (SSI), and seroma. Meta-analyses were performed in R studio using random-effects models, with results reported as odds ratios (OR) with 95
