Antiplatelet Therapy in Inguinal Hernia Repair: To Continue or Interrupt? A Systematic Review and Meta-Analysis.

Surgical site occurrence (SSO) and surgical site infection (SSI) are common concerns with incisional hernia repair. Intraoperative drain placement is a common practice aiming to reduce SSO and SSI rates. However, literature on the matter is very poor. The aim of this study is to investigate the role of subcutaneous and periprosthetic drain placement on postoperative outcomes and SSO and SSI rates with incisional hernia repair. A non-randomised pilot study was performed between January 2018 and December 2020 and included patients with elective midline or lateral incisional hernia repair with sublay mesh placement. Patients were prospectively included, followed for 1month and divided into three groups: group 1 without drainage, group 2 with subcutaneous drainage, and group 3 with subcutaneous and periprosthetic drains. Drains were placed at surgeon's discretion. All patients were included in the enhanced recovery program. One hundred and four patients were included. Twenty-four patients (23.1%) did not have drains (group 1), 60 patients (57.7%) had a subcutaneous drain (group 2) and 20 patients (19.2%) had both a subcutaneous and a periprosthetic drains (group 3). SSO rates were significantly different between the 3 groups: 20.8% in group 1, 20.7% in group 2 and 50% in group 3 (p = 0.03). There was no significant difference in deep and superficial SSI rates between the 3 groups. Subgroup analysis revealed that adding a drain in direct contact with the mesh significantly increased SSO rate but did not influence SSI rate. Length of stay was also significantly increased by the presence of a drain, 3.1 ± 1.9days for group 1; 5.9 ± 4.8 for group 2 and 5.9 ± 2.5days for group 3 (p < 0.005). Drain placement in direct contact with the mesh might increase SSO rate. More studies are necessary to evaluate the actual benefits of drainage after incisional hernia repair.

Incisional negative pressure wound therapy (iNPWT) may reduce surgical site infections (SSI), which can have devastating consequences after incisional hernia repair. Few comparative studies investigate the effectiveness of this wound management strategy in this population. The objective of this study is to determine the effect of iNPWT on the incidence of SSI after complex incisional hernia repair. All adult patients undergoing open incisional hernia repair at a single center from 2016 to 2019 were reviewed. A commercial iNPWT dressing was used at the discretion of the surgeon. Patients were grouped by type of dressing; iNPWT and standard sterile dressings (SSD). Coarsened exact matching was used to create balanced cohorts for comparison using age, sex, American Society ofAnesthesiologists classification, wound classification, and surgical urgency. The primary outcome was the composite incidence of superficial and deep SSI within 30days. Secondary outcomes included non-infectious surgical site occurrences (SSO), overall complications, length of stay (LOS), emergency department visits, and readmission at 30days. 134 patients underwent complex hernia repair, with 114 patients included after matching (34 iNPWT, 51 SSD). Composite incidence of superficial and deep SSI was 19.3% (11.8% vs. 27.5%, p = 0.107), with significantly lower rates of deep SSI in patients receiving iNPWT (2.9% vs. 17.6%, p = 0.045). After accounting for residual differences between groups, iNPWT was associated with decreased incidence of composite SSI (RR 0.36, 95% CI [0.16, 0.87]). Median LOS was longer in patients with iNPWT (7 vs. 5days, p = 0.001). There were no differences in SSO, overall complications, readmission, or emergency department visits. In patients undergoing incisional hernia repair, the use of iNPWT was associated with a lower incidence of SSI at 30days. Future studies should focus on cost effectiveness of iNPWT, its impact on long-term hernia recurrences, and the identification of patient selection criteria in this population.

Individual studies indicate poorer outcomes for smokers after hernia repair. Previous meta-analyses have examined the impact of smoking on specific outcomes such as recurrence and surgical site infection, but there has been a lack of comprehensive consensus or systematic review on this subject. Addressing this gap, our study undertakes a systematic review and meta-analysis to assess the impact of smoking on the outcomes of ventral hernia repair (VHR) and inguinal hernia repair. A thorough search of Cochrane Central, Scopus, SciELO, and PubMed/MEDLINE, focusing on studies that examined the effect of smoking on inguinal and VHR outcomes was conducted. Key outcomes evaluated included recurrence, reoperation, surgical site occurrences (SSO), surgical site infection (SSI), and seroma. Out of 3296 screened studies, 42 met the inclusion criteria. These comprised 25 studies (69,295 patients) on VHR and 17 studies (204,337 patients) on inguinal hernia repair. The analysis revealed that smokers had significantly higher rates of recurrence (10.4% vs. 9.1%; RR 1.48; 95% CI [1.15; 1.90]; P < 0.01), SSO (13.6% vs. 12.7%; RR 1.44; 95% CI [1.12; 1.86]; P < 0.01) and SSI (6.6% vs. 4.2%; RR 1.64; 95% CI [1.38; 1.94]; P < 0.01) following VHR. Additionally, smokers undergoing inguinal hernia repair showed higher recurrence (9% vs. 8.7%; RR 1.91; 95% CI [1.21; 3.01]; P < 0.01), SSI (0.6% vs. 0.3%; RR 1.6; 95% CI [1.21; 2.0]; P < 0.001), and chronic pain (9.9% vs. 10%; RR 1.24; 95% CI [1.06; 1.45]; P < 0.01) rates. No significant differences were observed in seroma (RR 2.63; 95% CI [0.88; 7.91]; P = 0.084) and reoperation rates (RR 1.48; 95% CI [0.77; 2.85]; P = 0.236) for VHR, and in reoperation rates (RR 0.99; 95% CI [0.51; 1.91]; P = 0.978) for inguinal hernias between smokers and non-smokers. Analysis using funnel plots and Egger's test showed the absence of publication bias in the study outcomes. This comprehensive meta-analysis found statistically significant increases in recurrence rates, and immediate postoperative complications, such as SSO and SSI following inguinal and VHR. Also, our subgroup analysis suggests that the MIS approach seems to be protective of adverse outcomes in the smokers group. However, our findings suggest that these findings are not of clinical relevance, so our data do not support the necessity of smoking cessation before hernia surgery. More studies are needed to elucidate the specific consequences of smoking in both inguinal and ventral hernia repair. ID CRD42024517640.

Surgical site infection (SSI) is one of the most common complications after abdominal surgery. The present trial examined the efficacy of saline irrigation of open appendectomy wound with or without topical antibiotics in prevention of SSI. This was a double-blind randomized trial on patients with acute appendicitis who underwent open appendectomy. Patients were randomly allocated to one of three equal groups; group I had layer-by-layer wound irrigation with gentamicin-saline solution, group II had wound irrigation with saline solution, and group III received no irrigation (Control group). The main outcome measures were the incidence of incisional SSI, surgical site occurrence (SSO), other complications, operation time, postoperative pain, and patients' satisfaction. 205 patients (113 female) of a mean age of 27.9 years were included. The average hospital stay and pain scores were similar in the three groups. Groups I and II had significantly lower rates of incisional SSI (4.3% Vs 2.9%; Vs 17.4%, p=0.005) and SSO (24.6% Vs 13.4% Vs 43.5%; p=0.0003) as compared to group III. Groups I and II had comparable rates of SSI and SSO. The three groups had similar rates of wound seroma, hematoma, and dehiscence. Groups I and II had significantly higher satisfaction with the procedure than group III. Layer-by-layer irrigation of open appendectomy wound decreased the rates of incisional SSI and SSO significantly compared to the no-irrigation group. Adding gentamicin to saline solution was useless to improve the outcome and did not decrease rates of SSI or other complications.

Patients undergoing Hartmann's reversal (HR) frequently present with an incisional hernia. It is not clear whether HR and incisional hernia repair (IHR) should be performed simultaneously, given the high risk of complications. The aim of this study was to evaluate the outcomes of concomitant HR and IHR. Patients who underwent HR between 2012 and 2024 were revised. The sample was divided into two groups: patients who underwent HR alone (HR) and those with concomitant HR and IHR (CP). The primary outcomes were 30-day overall morbidity, major morbidity (Clavien-Dindo III/IV complications), and anastomotic leak rates. Secondary outcomes were surgical site infections (SSI), surgical site occurrences (SSO), length of stay (LOS), reoperation rates, mortality, and hernia recurrence. A total of 52 patients were analyzed: 35 (67%) HR and 17 (33%) CP. Demographic variables were similar between groups. Operative time (HP: 196 vs. CP: 286 min, p = 0.001) was longer in the CP group. Most HR were laparoscopically performed (HR: 33 (94.2%) vs. CP: 2 (11.7%), p < 0.001). 30-day overall morbidity (HR: 15 (42.8%) vs. CP: 12 (70.5%), p = 0.06), major morbidity (HR: 2 (5.7%) vs. CP: 4 (23.5%), p = 0.06), and anastomotic leak (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48) rates were similar between groups. No significant differences were observed regarding SSI (HR: 9 (25.7%) vs. CP: 3 (17.6%), p = 0.72) or reoperation rates (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48). LOS was similar between groups (HR: 5 (2-16) days vs. CP: 6 (3-13) days, p = 0.2). No recurrences were observed in the CP group after a mean follow-up of 49 (12-132) months. One patient died in the HR group (HR: 1 (2.8%) vs. CP: 0 (0%), p = 0.48). Simultaneous HR and IHR might be feasible in very selected patients treated by experienced colorectal and abdominal wall surgeons. The small, heterogeneous, and imbalanced patient cohorts of our study, however, warrant further research to support the safety of the combined approach.

Program and AbstractsThirty-third Annual Meeting of the Surgical Infection SocietyLas Vegas, NevadaApril 12–15, 2013

The efficacy of negative-pressure wound therapy (NPWT) in the prevention of surgical site occurrences in open abdominal surgery: A randomized clinical trial

Development and Validation of a Risk-Stratification Score for Surgical Site Occurrence and Surgical Site Infection after Open Ventral Hernia Repair

The incidence of ventral hernia development after solid organ transplantation has been reported to be up to 30%. We aim to determine the impact of previous solid organ transplant on post-operative length of stay (LOS) and surgical site complications in elective ventral hernia repairs. A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was conducted to include all patients age 18years or older who underwent elective incisional hernia repair. Those with and without a history of solid organ transplantation were compared. The primary outcome was in-hospital LOS. Secondary outcomes included 30-day surgical site infection (SSI) rate, 30-day surgical site occurrence requiring procedural intervention (SSOPI) rate, 30-day overall post-operative complications and recurrence. The association between transplant and the LOS was tested with a negative binomial regression model adjusted for the demographic characteristics, comorbidities and hernia characteristics in the model. The population analyzed included 13,452 (98.79%) patients without a history of organ transplantation and 165 (1.21%) patients who had a history of organ transplantation. After adjusting for age, hernia width, BMI, gender, race, insurance type, ASA class, hypertension, dyspnea, OR time > 2h, abdominal wall SSI history, recurrent hernia, operative approach the median LOS was not significantly different between patients with a history of solid organ transplant [2.8 (2.6, 2.9) days] and those without [2.6days (2.2, 3.1)] (p = 0.5). The proportion of SSI (2.4% vs 4.04%; p = 0.42), SSOPI (4.2% vs 5.8%; p = 0.38) and recurrence (0.6% vs 0.4%, p = 0.51) was similar between both groups. Other remaining 30-day post-operative were negligible in our sample. There were no significant differences in LOS or infection rates between patients with and without a history of solid organ transplantation despite known risks of immunosuppression and chronic steroid use. Therefore, although these patients have many classic risk factors for poor outcomes, the data suggest that their history of solid organ transplantation should not preclude them from surgery.

Influence of complications on patient-reported outcome measures in 5,312 prospectively registered abdominal wall reconstructions using propensity score matching.

To analyze the incisional hernia recurrence rate at a long-term follow-up using a biosynthetic long-term absorbable mesh in patients with a higher risk of surgical infection in a contaminated surgical field. This was a retrospective multicentric study. All patients undergoing incisional hernia repair between 2016 and 2018 at 6 participating university centers were included. Patients were classified according to the Ventral Hernia Working Group (VHWG). All consecutive patients who underwent abdominal wall repair using biosynthetic long-term absorbable mesh (Phasix®) in contaminated fields (grade 3 and 4 of the VHWG classification) were included. Patients were followed-up until September 2021. Preoperative, operative, and postoperative data were collected. All patients' surgical site infections (SSIs) and surgical site occurrences (SSOs) were recorded. The primary outcome of interest was the clinical incisional hernia recurrence rate. One hundred and eight patients were included: 77 with VHWG grade 3 (71.3%) and 31 with VHWG grade 4 (28.7%). Median time follow-up was 41months [24; 63]. Twenty-four patients had clinical recurrence during the follow-up (22.2%). The SSI and SSO rates were 24.1% and 36.1%, respectively. On multivariate analysis, risk factors for incisional hernia recurrence were previous recurrence, mesh location, and postoperative enterocutaneous fistula. At the 3year follow-up, the recurrence rate with a biosynthetic absorbable mesh (Phasix®) for incisional hernia repair in high-risk patients (VHWG grade 3 and 4) seemed to be suitable (22.2%). Most complications occurred in the first year, and SSI and SSO rates were low despite high-risk VHWG grading.

PurposeMesh suture is a novel reinforcement construct designed to provide enhanced mechanical support during midline fascial closure in comparison to conventional sutures while minimizing tissue dissection and foreign body burden in comparison to use of a planar mesh. Its use in contaminated fields remains understudied. This study evaluates the early clinical outcomes following mesh suture closure in clean-contaminated and contaminated incisional hernia repairs.MethodsA retrospective review was conducted of patients undergoing incisional hernia repair with mesh suture closure between January 2023 and July 2024 across an academic health system. Eligible patients had clean-contaminated or contaminated wounds and underwent mesh suture implantation without planar mesh. Data included demographics, operative details, surgical site infections (SSI), surgical site occurrences (SSO), reoperations, readmissions, and hernia recurrence. Hernia recurrence-free survival was estimated using Kaplan-Meier analysis. Major complications were defined as surgical complication or reoperation within 90 days.ResultsFifty-one patients were included, with repairs performed by 22 surgeons. Most patients (62.7%) had clean-contaminated wounds. Anterior component separation was performed in 25.5% of cases. The 90-day SSI rate was 15.7%, with five patients requiring procedural intervention. The 90-day SSO rate was 23.5% and included one enterocutaneous fistula that resolved without surgical intervention. Readmission occurred in 27.4% of patients, and 9.8% underwent reoperation. Four hernia recurrences were observed (8.2%), with a 12-month recurrence-free survival of 91% and a mean recurrence-free survival of 17.3 months (95% CI: 16.5–18.1). Presence of a stoma was significantly associated with major complications (p = 0.041).ConclusionMesh suture closure was technically feasible across diverse surgical settings and demonstrated encouraging SSI and SSO rates as compared to conventional suture only and planar mesh-based repairs as reported in the literature. These findings support further investigation in prospective, comparative studies to assess long-term durability and comparative effectiveness.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10029-025-03422-8.

Surgical site infections (SSIs) are the most common healthcare-associated infections in patients undergoing surgery. Various randomised control trials (RCTs) indicate that laparoscopic procedures can be associated with better outcomes compared to open procedures. However, how open versus laparoscopic approaches compare across various paediatric procedures with respect to SSI rate remains poorly defined. In this review, we examined RCTs that directly compare SSI rates after open versus laparoscopic operations for appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis. MEDLINE, Embase, and Web of Science were searched for RCTs comparing four types of open versus laparoscopic operations in children. The operations included appendectomy, fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy. 364 records were identified and screened, 54 full-text articles were assessed for eligibility, and 17 RCTs were included in the analysis. SSI rate was the primary outcome. Operative time and length of stay (LOS) were the secondary outcomes. A meta-analysis was conducted using RevMan 5.4 software. Laparoscopic appendectomy had a lower SSI rate than open appendectomy (odds ratio of 2.22 [1.19, 4.15] p = 0.01). Laparoscopic fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy for pyloric stenosis were not associated with lower SSI rate compared to open surgery. Operative time was shorter in open fundoplication (- 71.22 min [- 89.79, - 52.65] p < 0.00001) than laparoscopic fundoplication. There was no significant difference in operative time of any of the other procedures. There was no significant difference in LOS between open and laparoscopic procedures for all types of operations analysed. Based on the findings of this review, it is recommended to utilise the laparoscopic approach over the open approach to reduce SSI risk in paediatric appendectomy.

Do risk calculators accurately predict surgical site occurrences?

Negative-Pressure Wound Therapy in the Management of High-Grade Ventral Hernia Repairs