Search Results (42)

Ventral incisional hernia is a frequent postoperative complication following abdominal surgery, with recurrence largely driven by biomechanical factors such as elevated intra-abdominal pressure and stress concentration at the suture–mesh–tissue interface. This study presents a patient-specific finite element analysis (FEA) framework to investigate stress transfer mechanisms within ventral incisional hernia repair systems under physiologically relevant loading conditions. A patient-specific abdominal wall geometry was reconstructed from computed tomography images and modeled as a nonlinear hyper-elastic material using a second-order Ogden formulation. Polypropylene surgical meshes and sutures were represented using finite elements, and an intra-lay mesh placement with a midline incision was simulated. Loading conditions corresponding to regular breathing, forceful breathing, and heavy-load lifting were applied. The results reveal that stress concentrations consistently localize at the sutures, with stress magnitudes increasing markedly under higher physiological loads. Under heavy lifting, suture stresses approached the material yield limit, whereas mesh stresses remained comparatively low. These findings identify suture failure as a critical mechanical factor contributing to hernia recurrence and highlight the importance of postoperative load management and improved support strategies. This work provides a basis for more comprehensive future patient-specific analyses. Full article

Acute parastomal hernia containing the stomach with subsequent mechanical gastric outlet obstruction is an exceedingly rare phenomenon given the anatomical fixation of the stomach. Herein, we present the case of an 81-year-old female with a history of a Hartmann’s procedure who developed acute vomiting. She was found to have herniation of the stomach into the parastomal hernia sac with tight angulation of the gastroduodenal junction and, therefore, gastric outlet obstruction. Following decompression with a nasogastric tube, we report an open approach with circumstomal mesh for acute emergent repair. Full article

Background: Ventral hernias are a common complication following abdominal surgery, occurring in up to 20% of patients after midline laparotomy and as many as 43% of those who undergo orthotopic liver transplantation (OLT). These hernias pose unique challenges due to chronic immunosuppression, impaired wound healing, and the anatomic disruption caused by subcostal and “Mercedes-Benz” incisions. As survival after OLT continues to improve, the need for durable, infection-resistant abdominal wall reconstruction has become increasingly important. Methods: We performed a single-institution retrospective review of all OLT patients undergoing abdominal wall reconstruction by the senior author between June 2014 and April 2026. Our approach emphasizes component separation to reestablish myofascial continuity, biologic onlay reinforcement with human acellular dermal matrix (HADM), and multipoint fixation in a progressive tension pattern. Results: Forty patients (43 encounters) were included. Mean age was 55.7 ± 10.2 years, mean BMI was 31.2 ± 4.9 kg/m², and 60.0% were obese. The majority presented with recurrent hernias (67.4%), and 41.9% had prior mesh in situ. Component separation was performed in all cases, and intraoperative Botox in 18.6%. HADM was used in 83.7% of encounters. At a mean follow-up of 34.0 months, there was 1 hernia recurrence (2.3%). The surgical site occurrence rate was 14.0%, with seroma as the most common complication (9.3%). There were no 30-day mortalities. Conclusions: By integrating biologic and mechanical principles, this reconstructive strategy provides a durable solution for abdominal wall repair in liver transplant recipients. A 2.3% recurrence rate and 14.0% surgical site occurrence rate compare favorably to published benchmarks in the transplant population. Full article

Background/Objectives: Mesh repair reduces hernia recurrence compared with suture repair, but permanent synthetic meshes are associated with chronic foreign-body complications. Biosynthetic poly-4-hydroxybutyrate mesh (Phasix™) provides temporary reinforcement with gradual resorption; however, short-term real-world outcomes across different hernia types remain limited. This study evaluated short-term outcomes after Phasix™ hernia repair and identified factors associated with baseline recurrent hernia at presentation. Methods: This retrospective cohort included patients ≥ 16 years who underwent open or laparoscopic hernia repair with Phasix™ at King Abdulaziz Medical City (2020–2023). Patients receiving other mesh types were excluded. Demographic, operative, and postoperative data were analyzed. Multivariable logistic regression identified factors associated with baseline recurrent hernia. Results: Among the 228 patients (51.8% female; mean age 55 years), hernia types were incisional (36.0%), paraumbilical (26.3%), and inguinal (24.6%). Early complications were uncommon: seroma in 2.2% and surgical site infection in 1.8% at 1 month. One-year recurrence occurred in 1.3% (3/228). Female sex, prior incisional hernia repair, previous mesh removal, and open repair independently predicted baseline recurrent hernia, while laparoscopic repair was protective. Conclusions: Phasix™ repair demonstrated low short-term complication rates and rare 1-year recurrence across ventral and inguinal hernias. Short-term outcomes were driven mainly by patient and procedural factors rather than mesh-specific effects. Full article

Background and Objectives: Intraperitoneal onlay mesh (IPOM) reduces ventral/incisional hernia recurrence but raises concern for adhesions and infection, particularly when the operative field is not strictly clean. We aimed to determine how contamination severity modulates the peritoneal response to intraperitoneal polypropylene mesh. Materials and Methods: In a prospective, randomized, blinded rat study, 60 male Wistar rats were allocated to three groups (n = 20/group) and evaluated at postoperative day (POD) 4 and POD 8 (n = 10/timepoint): A, clean mesh placement; B, small-bowel resection with end-to-end anastomosis without spillage (“potentially septic”); and C, mesh placement followed by intraperitoneal inoculation with Escherichia coli and Staphylococcus aureus (“controlled contamination”). The primary outcome was adhesion severity (Van der Ham scale, 0–3). Secondary outcomes included semi-quantitative histological scores (0–4) for neutrophil infiltration, fibroblast proliferation, neoangiogenesis, and collagen deposition. Prespecified non-parametric analyses were applied. Results: All animals completed follow-up; no pre-sacrifice deaths occurred. Adhesion severity showed no statistically significant differences between Groups A and B at either timepoint (mean POD4: 0.3 vs. 0.6; POD8: 0.4 vs. 0.8; p > 0.05). In contrast, Group C demonstrated markedly higher adhesion scores (mean POD4: 2.3; POD8: 2.4; both p < 0.001 vs. Groups A and B), with a substantially greater proportion of grade 2–3 adhesions. Histological parameters paralleled these findings: at both POD4 and POD8, Group C showed significantly higher neutrophil, fibroblast, neoangiogenesis, and collagen scores compared with Groups A and B (all p < 0.001). No statistically significant within-group temporal differences were observed between POD4 and POD8. Conclusions: In this experimental model, intraperitoneal polypropylene mesh demonstrated similar early biological response patterns in clean and controlled contamination settings, whereas established intra-abdominal sepsis was associated with a marked escalation of inflammation, fibroproliferation, and adhesion formation. These findings suggest that selective use of synthetic intraperitoneal mesh may be considered when contamination is controlled, while caution is warranted in frankly septic environments. Full article

Background: Overweight and obesity are major health problems of the 21st century. As a significant risk factor for numerous noncommunicable diseases, obesity is also strongly associated with the development of abdominal hernias, which significantly impair patients’ quality of life. The review focuses on the pathophysiological mechanisms linking obesity to hernias and the impact of key prehabilitation components. Available research indicates a complex interrelationship between obesity and the development of ventral hernias, driven by pathophysiological mechanisms such as increased intra-abdominal pressure and chronic inflammation, which weakens the collagen matrix of the abdominal wall. Furthermore, both smoking and alcohol consumption significantly increase the risk of abdominal obesity and surgical complications; in turn, physical activity is crucial for reducing visceral fat. Psychological support may reduce pre-operative stress and contribute to improved outcomes. Nutritional intervention and weight loss are other essential components of preoperative management for ventral hernia repair. This review aims to highlight the role of prehabilitation in ventral hernia surgery in obese patients and to propose a structured, evidence-based algorithm (DEPP) for this high-risk population. The algorithm includes: Dietary intervention (D), Elimination of smoking and alcohol consumption (E), Physical activity (P), and Psychological support (P). The algorithm was developed to systematize the clinical approach and determine the steps to be taken in the treatment of patients with obesity and abdominal hernia. Methodology: A literature search was conducted across PubMed, Scopus, and Google Scholar databases for articles published between 2002 and 2026. We included randomized controlled trials, prospective/retrospective cohort studies, systematic reviews, and meta-analyses. Conclusions: Prehabilitation is a multifaceted strategy for optimizing the health of patients with obesity prior to abdominal hernia repair. The proposed prehabilitation algorithm, known as DEPP, is a preliminary approach for managing this group of patients. Full article

Purpose: Giant inguinal hernias (GIHs) are rare and technically demanding conditions, associated with loss of domain and abdominal wall compliance. Preoperative botulinum toxin type A (BtxA) has been increasingly used in complex ventral hernia repair to facilitate abdominal wall relaxation; however, its role in GIHs surgery remains poorly defined. This scoping review aimed to map the literature on preoperative BtxA use in GIHs repair, focusing on technical protocols, patient selection, and areas of variability. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. MEDLINE, Embase, Web of Science, and Scopus were searched from inception to 10 October 2025. Studies reporting preoperative BtxA administration in adult patients undergoing GIHs repair were included. Data were extracted descriptively and synthesized narratively. Results: Seven observational and non-comparative studies published between 2019–2025 were included, comprising a total of 16 patients. Substantial heterogeneity was observed in BtxA protocols, with total doses ranging from 100 to 450 units, injection timing between 2 and 8 weeks preoperatively, and injection sites varying from 6 to 18. In several reports, BtxA was used as part of a multimodal preoperative strategy including progressive pneumoperitoneum. All studies targeted the lateral abdominal wall musculature, employed imaging guidance, and performed bilateral injections. Patient selection criteria and outcome reporting were inconsistent. Conclusions: Preoperative BtxA use in GIHs repair is limited and heterogeneous. No standardized protocol can be identified. Further anatomically focused and systematically designed studies are required to clarify the role of BtxA and to establish standardized preoperative protocols for this challenging surgical condition. Full article

Background and Objectives: There are many well-described approaches to symptomatic ventral hernia management; however, there remains a significant patient population with limited options for a durable ventral hernia repair with a reasonable risk of infection and recurrence. Drawing from the orthopedic literature, we changed our approach to this clinical problem and developed a palliative ventral hernioplasty pathway. Materials and Methods: A retrospective review (2017–2019) of patients’ palliative ventral hernioplasty was performed. Results: In total, 43 patients included, with a female preponderance of 24 (58.6%) and a mean age 61.5 ± 11.5 years. The mean BMI was 38.1 kg/m² (IQR: 25.4–62), and 28 patients (65.1%) had a history of prior wound/mesh infection. Urgent repair was performed in 14 patients. Overall polypropylene prosthetic was implanted in 26 patients, and bioprosthetic/absorbable mesh was used in the remaining. The mean surface area of the implanted mesh was 561 cm². The most common wound complications identified were skin separation (30.2%) and seroma formation (48.8%). Hernia recurrence occurred in four (9.3%) patients, with a mean follow-up of 24.1 months (9–37). Three patients had central lightweight mesh rupture and one had a recurrence (bioprosthetic mesh); all were subsequently repaired. Conclusions: Despite the small number of patients, our palliative ventral hernia repair pathway offers durable repair with an acceptable risk of recurrence and mesh infection in patients who would otherwise be considered nonoperative. Full article

Background: Primary ventral hernias (PVHs) are a frequent disease that can impair quality of life. Laparoscopic intraperitoneal onlay mesh (IPOM) technique has shown good outcomes in appropriately selected cases. Methods: We report the results of a retrospective analysis involving 200 consecutive patients who underwent laparoscopic ventral hernia repair with a standardized technique using a single mesh from January 2011 to September 2024 to define the safety of laparoscopy in ventral hernia treatment. Results: The study included 147 umbilical hernias (73%) and 53 epigastric hernias (27%). The average defect measured 3 cm, with sizes ranging from 2 to 7 cm. After a mean follow-up of 1708 days (range 117–4642), no complications associated with the mesh were observed; there was only one (0.5%) recurrence documented and no bulging was observed. Conclusions: Laparoscopic repair of PVH using a standardized technique and using the same mesh, which has been proven safe over the last 15 years, offers good results. Full article

Background: Marfan syndrome is an autosomal dominant connective tissue disorder that affects multiple organ systems, with cardiovascular complications posing a major risk. With advancements in medical care and the increasing lifespan of patients with Marfan syndrome, the spectrum of medical issues has evolved. This case report highlights the complex anaesthetic management of a patient with Marfan syndrome during elective ventral hernia repair. Case presentation: A 37-year-old male with Marfan syndrome was admitted for elective open ventral hernia repair. Challenges included severe arterial hypertension, prior aortic valve replacement, scoliosis, and an anticipated difficult airway, as the patient presented with restricted mouth opening due to craniofacial abnormalities consistent with difficult laryngoscopy. Preoperative assessments included routine tests, echocardiography and chest X-ray. The anaesthetic management focused on specific patient positioning with head-up tilt, maintenance of haemodynamic stability with the insertion of an arterial line before the induction of anaesthesia and neuromuscular block (NMB) monitoring, followed by titrated doses of all medications. Lung ventilation strategies were specifically adjusted to address the patient’s underlying comorbidities. The patient was extubated and transferred to the recovery unit. The intraoperative and immediate postoperative periods were relatively uneventful. Dyspnea due to external pressure on the abdominal wall caused by a specific binder was treated with the release of pressure. Later postoperative recovery was complicated by hydrothorax and pneumonia, both treated successfully. Conclusions: This case emphasises the importance of multidisciplinary approaches and vigilant monitoring in the management of a patient with Marfan syndrome perioperatively, even for seemingly low-risk operations. Appropriate anaesthetic management helped to avoid major perioperative complications. Full article

The operative management of complex abdominal wall hernias in nonagenarians entails significant risk, with emergent repair associated with mortality rates approaching 40%. We report the case of a functionally independent 90-year-old male presenting with a 48 h history of abdominal pain, obstipation, and emesis, consistent with an acute-on-chronic incarcerated ventral hernia. Despite advanced age and elevated perioperative risk, multidisciplinary evaluation supported surgical intervention. Laparotomy revealed a 22 × 18 cm hernia sac harboring an elongated sigmoid and approximately 150 cm of small intestine with signs of compromised perfusion secondary to an internal constriction band. Following adhesiolysis and decompression, bowel viability was restored, and a mesh repair was performed. The postoperative course was notable for transient respiratory failure necessitating reintubation and ICU management; however, full recovery was achieved by one-month follow-up. This case demonstrates that comprehensive assessment, rather than chronological age, should guide operative decision-making in nonagenarians and underscores the feasibility of complex abdominal wall reconstruction in this cohort when supported by multidisciplinary care and perioperative resources. Full article

Background: The aim was to explore patients’ reflections related to their choice of participating or not in a multimodal prehabilitation randomised controlled trial (RCT) in relation to minor surgery. Methods: A qualitative study with 22 semi-structured in-depth interviews on patients awaiting ventral hernia repair was conducted between March and May 2024 and reported according to the COREQ guideline. All were eligible to participate in a prehabilitation RCT; twelve had accepted, and ten had declined. The interviews were analysed using Kirsti Malterud’s method of systematic text condensation, resulting in themes. Results: Five global themes were identified: “time commitment”, “research participation for the general good”, “personal benefits of RCT participation”, “ambivalence of own health and lifestyle”, and “complications after surgery”. All participants found the RCT and its prehabilitation programme a positive initiative. Those who had accepted to participate in the RCT emphasised personal benefits and contributing to research, while those who had declined expressed more ambivalence regarding lifestyle change, the extent of personal advantage, and prioritising of time. Conclusions: Those who declined RCT participation generally had more elaborate and ambivalent reflections than those who had accepted. Addressing ambivalence regarding lifestyle change, personal benefits, and prioritising time might be a relevant focus point for increasing inclusion rates in prehabilitation RCTs and in clinical practice to increase patients’ readiness for lifestyle change. Full article

Background/Objectives: Ventral hernia repair has evolved with the introduction of minimally invasive techniques like l-IPOM and rTA-RM. While robotic surgery offers advantages in precision and ergonomics, its higher costs pose questions regarding its cost-effectiveness compared to laparoscopic approaches. Methods: A retrospective analysis of patients with primary or incisional ventral hernias undergoing either l-IPOM or rTA-RM between February 2022 and October 2023 was conducted. Data on demographics, surgical outcomes, hospital costs, disposable supplies, and robotic system expenses were collected. A one-to-one propensity score matching (PSM) was used to ensure comparability between the groups. Results: After matching, 30 patients were included in each group. The rTA-RM group had longer operative times (93.2 vs. 74.4 min, p = 0.004) but shorter hospital stays (1 day vs. 2 days, p = 0.003) and lower postoperative pain scores (median VAS score 3 vs. 5, p = 0.004). Total costs were comparable between rTA-RM and l-IPOM (EUR 6862 vs. EUR 6575, p = 0.32), with robotic surgery incurring higher capital costs but lower disposable supply costs (EUR 1057 vs. EUR 2006, p < 0.01). Conclusions: Despite the higher per-case cost associated with robotic systems, overall costs for rTA-RM were similar to those for l-IPOM, suggesting that robotic surgery may be cost-competitive due to lower disposable supply expenses and shorter hospital stays. Further research is needed to assess long-term outcomes and broader economic impacts. Full article

Objectives: The objective of this study was to assess the tissue response and strength of traditional and unidirectional suture materials, depending on the conditions of use and the timing following implantation. Methods: Eighty male Wistar rats were randomly assigned to four groups depending on the suture used: unidirectional absorbable V-loc^TM 180 or non-absorbable V-loc^TM PBT and traditional absorbable Maxon^TM or non-absorbable Novafil^TM. Three and six weeks following the closure of the abdominal wall defect (AWD) and subcutaneous suture implantation at the withers according to group assignment, 10 animals from each group were euthanized for implanted sutures mechanical testing and histological examination. Results: The inflammatory reaction in the AWD closure area was maximal and significantly different from the subcutaneous implantation by week 3 for all groups. At six weeks, the tissue reaction did not depend on the place of implantation. However, four rats from the Maxon^TM group demonstrated suture failure with diastasis formation. Non-absorbable barbed sutures exhibited an absence of suture failure and the maximum scar thickness. Both intact absorbable materials (V-Loc^TM 180 and Maxon^TM) exhibited a significant breaking strength margin over the non-absorbable. By week 6, the preserved strength of the V-loc^TM 180 sutures at the AWD was 33% (15–58%), and under the skin—49.7% (48–59%) (p = 0.005). For Maxon^TM, these values were 38% (35–48%) for the AWD and 44% (34–49%) for the subcutaneous implantation. Conclusions: Absorbable and non-absorbable suture materials, depending on the conditions and timing of implantation, cause various tissue reactions which could affect the wound healing and the number of postoperative complications. Full article

Background: Ventral hernias are common abdominal wall defects requiring surgical repair to prevent complications. This study compared two techniques: minimally invasive enhanced-view totally extraperitoneal (eTEP) approach and the open sublay (OS) method, historically regarded as the gold standard. Methods: A retrospective single-center study was conducted between July 2019 and March 2023 at the Department for General and Visceral Surgery, Klinikum Oldenburg. All patients who underwent either eTEP or OS for ventral hernia repair were included. Patient demographics and perioperative data were collected and compared. Results: A total of 139 patients were analyzed, with 92 undergoing eTEP repair and 47 undergoing OS. Both groups were comparable in demographic and clinical characteristics. Significant differences were found in defect size (median 6 cm² for eTEP vs. 16 cm² for OS, p < 0.028) and mesh size (median 450 cm² for eTEP vs. 150 cm² for OS p < 0.001). Operative time (p = 0.119) and postoperative pain levels over 3 days showed no significant differences (VAS Day1 p = 0.884; VAS Day3 p = 0.636). Intraoperative complications were 2.17% for eTEP and 6.38% for OS (p = 0.207). Postoperative complications (6.52% vs. 21.28%, p = 0.009) and hospital stay (median 3 days vs. 5 days, p < 0.001) were significantly lower in the eTEP group. Conclusions: eTEP is a safe, effective procedure and appears to offer more advantages than OS for ventral hernia repair. It is associated with a significantly lower complication rate, as well as shorter hospital stay. Full article