Medical reversals in the surgical management of ventral hernia following the publication of randomized controlled trials.

Functional Status after Ventral Hernia Repair: Longitudinal Trends and the Limits of Improvement.

Risk factors for recurrence of congenital diaphragmatic hernia in the era of minimally invasive surgery.

Many techniques can reapproximate fascia during herniorrhaphy. Reports suggest utility of interrupted figure-of-eights for large defects less amenable to running suture closures. However, anecdotal concerns regarding 'ischemic' qualities of figure-of-eights may dissuade utilization, despite no substantiating evidence. This study compares wound morbidity for figure-of-eights vs running sutures for fascial closure during open ventral hernia repair (VHR). A prospectively maintained hernia-specific registry was queried for open VHRs from 1/1/2014 to 12/31/2023 with fascial closure, ≥ 10cm defect width, CDC Class 1 wound, fascial closure via figure-of-eights or running suture, and clinical follow-up at 30days. Cases featuring anterior myofascial or cutaneous flaps were excluded. Surgical site occurrence (SSO), surgical site infection (SSI), SSO/SSI requiring procedural intervention (SSO/I-PI), recurrence, and patient-reported quality-of-life (QoL) at 30-day and 1-yearintervals were considered. SSO at 30days was selected as the primary outcome to serve as a surrogate for suture line ischemia, and 1-year recurrence was a key secondary outcome of interest. Baseline factors including age, BMI, gender, race, ASA class, immunosuppressant use, smoking, diabetes, hernia width, and hernia length were controlled via multivariable regression. A total 4195 cases met criteria and 31% utilized figure-of-eights (n = 1317). Multivariable logistic regression found no increased risk of 30-day SSO or 1-year recurrence for figure-of-eight vs running suture closure. Adjusted odds of SSI (OR 1.47; 95% CI 1.11, 1.95) and SSO/I-PI (OR 1.31; 1.02, 1.70) were greater for figure-of-eight closures. No associations were identified regarding patient-reported QoL or 1-year outcomes. This retrospective analysis of wound morbidity in clean cases identified an increased risk of SSI and SSO/I-PI for figure-of-eight closures at 30days vs running closures. Though the association may relate to residual confounding from selective utilization in high complexity repairs rather than an ischemic nature, the results suggest figure-of-eights should perhaps be reserved for challenging or high-tension fascial reapproximation.

Patient-reported outcomes after sutured repair of primary ventral hernias with permanent versus slowly absorbable sutures: a nationwide survey- and register-based study.

Minimally invasive ventral hernia repair has traditionally been performed using intraperitoneal onlay mesh (IPOM). Although effective, IPOM places mesh within the peritoneal cavity, with potential risks related to adhesions and mesh-bowel interaction. Enhanced-view totally extraperitoneal (eTEP) repair recreates the retromuscular (Rives-Stoppa) plane using a laparoscopic approach and may reduce these concerns. A prospective, observational study was conducted on n = 24 adult patients undergoing eTEP retrorectus ventral hernia repair. Perioperative outcomes, post-operative pain (Visual Analogue Scale), complications, quality of life (Carolinas Comfort Scale; HerQLes) and abdominal wall function (double-leg lowering and trunk-raising tests) were assessed at 7 days, 1 month and 3 months. The mean age was 45.6 ± 13.7 years; 54.2% were women. Mean operative time was 167.0 ± 28.7 min; no intraoperative visceral or vascular injury occurred. Surgical-site infection and seroma occurred in one patient each (4.2%) at 7 days and resolved by 1 month. Pain peaked in the early post-operative period and declined significantly over the follow-up (repeated-measures analysis of variance P < 0.001). Both CCS and HerQLes scores improved significantly at 1 and 3 months ( P < 0.001), with parallel improvement in abdominal wall function tests ( P < 0.001). In this early experience, eTEP retrorectus repair was feasible and safe with low early morbidity, significant improvement in patient-reported outcomes and improved abdominal wall function over 3 months. Larger comparative studies with longer follow-up are warranted.

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. 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. 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-5L questionnaires. Global preference and willingness to recommend each device were recorded. VAS scores were comparable between devices (p = 0.36), indicating no deterioration in perceived health state with corset use. No EQ-5D-5L 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). 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.

Complications After Enhanced-View Totally Extraperitoneal Ventral Hernia Repair: An Augmented Evidence Review Integrating ACHQC Registry Outcomes, Published Evidence, and Expert-Priority Polling.

Robot-assisted radical prostatectomy (RARP) has become the standard surgical treatment for prostate cancer. The Retzius-sparing approach (RS-RARP) offers improved functional outcomes; however, detailed data on non-functional perioperative and postoperative complications remain limited. This study aimed to evaluate the incidence, spectrum, and management of complications following RS-RARP in a large series and to assess the impact of progressive technical modifications. We performed a retrospective analysis of a prospectively maintained database of 1016 consecutive patients who underwent RS-RARP between 2016 and 2025. Complications were recorded intraoperatively and postoperatively and graded using the Clavien-Dindo classification. Functional outcomes were excluded. Temporal changes in surgical technique and perioperative protocols were analysed in relation to trends in complications. A total of 199 complications were recorded, with an overall complication rate of 18.2%. Most complications were low-grade, while major complications (Grade ≥ III) occurred in a minority. The most frequent complications included urinary tract infection (4.5%), urinary retention (3.5%), and incisional hernia (3.15%). Symptomatic lymphocele occurred in 0.89% and urethral stricture in 0.98%. Life-threatening complications were rare (0.3%), with one perioperative mortality (0.1%). Few targeted technical modifications were introduced during the study period, including oral antibiotic prophylaxis to prevent urinary tract infections, adoption of a Pfannenstiel incision for specimen extraction to reduce hernia rates, implementation of peritoneal distraction with the aim of reducing lymphocele rates, and optimization of catheter management protocols. These changes were associated with a reduction in procedure-specific complications over time. Although functional outcomes are routinely emphasized, non-functional surgical complications should also be addressed during preoperative counselling. In this large series, most complications were infrequent and manageable, with rates influenced by ongoing technical refinements. While lymphocele and urinary retention may be more frequent with the Retzius-sparing approach, a lower incidence of de novo inguinal hernia was observed. Targeted technical modifications, including Pfannenstiel specimen extraction and oral cefixime prophylaxis, were associated with reductions in specific postoperative complications, highlighting the importance of continuous refinement of surgical technique and perioperative care in optimizing outcomes following RS-RARP.

Contemporary abdominal wall reconstruction places a strong emphasis on optimizing extraperitoneal mesh placement. When the posterior layer is insufficient for closure, adjuncts such as hernia sac, omentum, or Vicryl mesh have been described. The outcomes of various posterior layer supplementation (PLS) materials, both autologous and non-autologous, have not been well examined. We aim to evaluate the outcomes of patients undergoing ventral hernia repair with extraperitoneal mesh placement who undergoPLS and compare howPLS materials impact these outcomes. All patients who underwent a retromuscular hernia (RM) repair with PLS between Jan 2021 and Jan 2025 at a single center were reviewed. Patient demographics, preoperative characteristics, intraoperative factors, and postoperative outcomes were evaluated. Descriptive statistics and comparative tests including Mann-Whitney U test, Student's t-test, and Fisher's exact test were utilized. Sixty-seven patients underwent RM repair with PLS. Supplement materials used included hernia sac, omentum, falciform ligament, prior mesh, new biologic, and biosynthetic coated mesh. Fifty-two percent (n = 35) of the repairs were retrorectus only and 48% (n = 32) were transversus abdominus releases. The average length of follow-up was 189days with a recurrence rate of 3%. Sixty percent of PLS was performed with autologous material with 40% utilizing new biologic or biosynthetic coated meshes. SSI, SSO, and SSOPI were similar between the autologous and non-autologous supplementation groups (p = 1, p = 0.16, p = 0.29, respectively). There were more postoperative bowel obstructions in the non-autologous group (n = 4) as compared to the autologous group (n = 0) (p = 0.02). All the bowel obstructions were managed nonoperatively. Our findings suggest that outcomes are acceptable with minimal morbidity when comparing autologous tissue to biologic and biosynthetic coated mesh for PLS. The low recurrence rates observed, regardless of the material used, support the continued adoption of this approach. Proactive supplementation of the visceral sac may decrease need for lateral myofascial release.

Background Abdominal Compartment Syndrome (ACS) is a catastrophic complication following complex hernia repair, particularly in patients with Type 2 Diabetes Mellitus (T2DM) who exhibit a phenotype of “metabolic vulnerability.” The interplay between preoperative nutritional depletion, chronic hyperglycemia, and systemic inflammation remains poorly understood in this context. Current risk assessment tools rely heavily on anatomical metrics and often fail to capture the synergistic impact of immuno-metabolic fragility. We aimed to develop and prospectively temporally validate a dynamic nomogram that integrates immuno-nutritional markers with surgical variables to predict ACS in diabetic patients. Methods We conducted a two-stage, prospective temporal validation study involving 555 diabetic patients undergoing elective complex hernia repair at a tertiary referral center. Phase I (January 2015 to December 2021) comprised a retrospective derivation cohort ( N = 461) that was randomly split into a training set ( n = 323) and an internal testing set ( n = 138) to identify predictors and construct the model. Phase II (January 2022 to December 2024) established a prospective temporal validation cohort ( N = 94) to verify model performance in a real-world clinical setting at the same institution. We utilized determining factors including the Hernia Sac Volume to Abdominal Cavity Volume (HSV/ACV) ratio, Nutritional Risk Screening 2002 (NRS-2002), Systemic Inflammatory Response Index (SIRI), and Glycated Hemoglobin (HbA1c). The primary endpoint was the development of ACS within 7 days postoperatively. Pre-specified sensitivity analyses included LASSO penalized regression with bootstrap optimism correction (1,000 resamples), modeling of all continuous predictors as restricted cubic splines, and comparison of nested models (anatomical-only vs. anatomical + metabolic vs. full nomogram) by decision curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results The study population exhibited a high baseline metabolic burden, with a mean body-mass index of 31.2 kg/m 2 and a mean HbA1c of 7.9%. Multivariable logistic regression identified seven independent predictors: HSV/ACV ratio ≥ 0.25 (Odds Ratio [OR], 2.75; 95% Confidence Interval [CI], 1.60–4.85), use of tension reduction procedures (OR, 2.45), operative time &amp;gt; 200 min (OR, 2.12), BMI ≥ 30 kg/m 2 (OR, 1.88), NRS-2002 score ≥ 3 (OR, 2.18), SIRI ≥ 1.6 (OR, 1.98), and HbA1c ≥ 6.0% (OR, 1.65). A positive correlation between SIRI and nutritional risk (Spearman ρ = 0.42, P &amp;lt; 0.001) was observed, consistent with an immuno-nutritional axis. The nomogram demonstrated good and stable discrimination, with an Area Under the Curve (AUC) of 0.89 (95% CI, 0.85–0.93) in the training cohort, 0.86 in the internal testing cohort, and 0.84 (95% CI, 0.77–0.91) in the prospective temporal validation cohort. Comprehensive calibration assessment in the prospective cohort showed a calibration slope of 0.91 (95% CI 0.74–1.08), calibration intercept of −0.09 (−0.31 to 0.13), Brier score 0.112, and a non-significant Hosmer–Lemeshow test ( P = 0.45). Bootstrap-based internal validation (1,000 resamples) yielded an optimism-corrected C-index of 0.87 and a calibration slope of 0.93. Risk stratification categorized patients into low, intermediate, and high-risk groups, yielding ACS incidence rates of 1.0%, 10.1%, and 72.7%, respectively ( P &amp;lt; 0.001). Compared with the anatomical-only baseline model, the full nomogram achieved an NRI of 0.31 (95% CI 0.18–0.44) and an IDI of 0.094 (95% CI 0.061–0.127), both P &amp;lt; 0.001. The high-risk phenotype was associated with significantly greater postoperative fluid sequestration, prolonged intensive care unit stays, and increased 30-days mortality. Conclusion The integration of immuno-nutritional markers (SIRI, NRS-2002) and glycemic control with anatomical parameters provides a temporally validated tool with good and stable discrimination for ACS in diabetic patients. Its principal clinical utility lies in reliable risk exclusion (negative predictive value 95.5% in the prospective temporal validation cohort), supporting safe rule-out of low-risk patients, while the more modest positive predictive value (46.4%) indicates that a high score should prompt enhanced surveillance and individualized decision-making rather than constitute a deterministic indication for pre-emptive open-abdomen management.

Despite being one of the most common procedures worldwide, with over 20 million cases annually, hernia repair overall continues to pose persistent challenges to clinicians. Challenges such as recurrence, chronic pain, and surgical site infections. Aside from surgical technique, preoperative optimization and postoperative follow-up can influence patient outcomes. However, practices vary widely and are influenced by practice type and patient-level barriers. We conducted a cross-sectional survey of practicing surgeons worldwide through Facebook hernia and abdominal wall surgery groups. The anonymous survey assessed existing prehabilitation programs, follow-up, and perceived limitations to optimal care. A total of 145 surgeons from 22 countries participated. Of these, 58% were abdominal wall and hernia specialists and 44% practiced in dedicated hernia centers. Overall, 74% routinely recommended prehabilitation and 66% did so for all patients. The most common components were weight loss, smoking cessation, and glycemic control. Surgeons in hernia centers were more likely to recommend smoking cessation (p = 0.005), diabetes control (p = 0.04), and exercise (p = 0.03). Specialists more frequently recommended prehabilitation in more than 75% of ventral hernia cases (p = 0.001) and atypical hernias (p < 0.001). Hernia society membership was the only independent predictor of routine prehabilitation recommendation (OR 6.30; 95% CI 1.56-29.58; p = 0.01). Regarding postoperative follow up, 50% reported a standardized protocol for all hernias and 30% for high risk or complex cases only. Follow up was primarily in-person 77%. Hernia centers more frequently reported longer term follow up of 1-5years for inguinal (p = 0.02), umbilical (p = 0.03), and non-complex ventral hernias (p < 0.001), as well as life-long follow up across hernia types. Abdominal wall and hernia specialty was independently associated with standardized follow-up protocols (OR 4.74; 95% CI 1.36-18.1; p = 0.017). Prehabilitation and follow-up remain heterogeneous with adherence limited by the combination of patient, surgeon, and system-level barriers. Differences in practices between high- and low-volume surgeons suggest opportunities for society-driven guidance, extending standardized protocols, and deploying adherence tools to improve consistency and outcomes.

The umbilicus is a distinct anatomical feature of the anterior abdominal wall, characterized by persistent postnatal depression. Despite its clinical and surgical relevance, the histological and spatial structures underlying the umbilical concavity remain unclear. Herein, we investigated the fibrous connective tissue underlying the umbilical concavity.Five formalin-fixed cadaveric specimens (mean age: 77.4 years) were used. Two were used for macroscopic dissection, two for histological examination, and one for quasi-continuous serial sectioning with three-dimensional reconstruction.Macroscopic dissection revealed a vertically cylindrical fibrous structure extending from the umbilical fossa to the anterior rectus sheath. Histological analysis confirmed that this structure enclosed a small fat compartment distinct from subcutaneous fat, representing an extraperitoneal fat protrusion in contact with the underside of the umbilical skin. Serial sections and three-dimensional reconstruction identified a tunnel-like fibrous structure, termed "umbilical sheath," enveloping the protruded fat and bridging the umbilical ring and dermis. This sheath connected the invaginated skin to the linea alba and rectus sheath.We identified a previously undescribed fibrous structure, the umbilical sheath, enclosing a localized protrusion of extraperitoneal fat, maintaining umbilical concavity. Recognition of this structure may guide optimal port placement and promote abdominal wall closure techniques that preserve anatomical support, potentially reducing incisional hernia risk.

An 85-year-old woman with a history of left breast cancer underwent 18F-FDG PET/CT for oncologic surveillance. Imaging demonstrated an incidental 7.5-cm intensely FDG-avid mass (SUVmax: 13.0) in the left lower abdominal wall, suspicious for metastatic disease. Incisional biopsy revealed fibrosis with multiple suture granulomas and foreign-body giant cell reaction, without malignancy. The patient had undergone transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction more than 10 years earlier, with subsequent ventral hernia mesh repairs. This case illustrates an important FDG-PET/CT pitfall of suture granuloma at remote reconstructive donor sites, which can mimic malignancy, persisting even decades after surgery.

Summary:Surgical intervention is recommended for patients presenting with ventral hernias accompanied by rectus diastasis. The priority goals of reconstruction are to restore normal abdominal wall anatomy and to minimize the risk of recurrence. Despite the availability of various surgical techniques, recurrence remains a significant concern for surgeons. This report presents the authors’ experience with abdominal wall reconstruction using autologous tissue. This surgical technique is indicated for patients presenting with a midline hernia with severe rectus diastasis (defined by an inter-rectus distance >5 cm). Initially, a conventional abdominoplasty was performed in combination with rectus abdominis muscle plication. The excised tissue was subsequently processed into dermal graft sheets through de-epithelialization and defatting using surgical scissors. These dermal sheets were then sutured to the abdominal aponeurosis to reinforce the repair. Wound closure was achieved using a tension-reducing technique to optimize healing and reduce postoperative complications. All patients were discharged uneventfully. Follow-up evaluations demonstrated favorable functional and aesthetic outcomes. Computed tomography performed 6 months after surgery revealed the contour of the transplanted dermal sheets, providing evidence supporting the effectiveness of dermal sheet reinforcement. Based on our experiences, for patients with fascia-based defects, particularly those with severe rectus diastasis associated with a midline hernia, this technique represents an efficient, cost-effective, and reliable reconstructive option.

Repair of moderate-to-large-sized ventral incisional hernias often requires component separation to achieve tension-free posterior layer closure. Transversus abdominis muscle release (TAR), although effective, increases operative complexity and morbidity. We describe a tissue-preserving laparoscopic transabdominal retromuscular repair with hernia sac-assisted mesh coverage without TAR. Five patients with incisional ventral hernia underwent this procedure. The hernia sac was carefully dissected while maintaining continuity with the peritoneum and used to cover the retromuscular mesh. Primary fascial closure was achieved using barbed sutures, and a polypropylene mesh was placed in the retrorectus plane. There were no intraoperative complications. Seroma occurred in three patients and resolved with conservative management without aspiration. At a median follow-up of 10 months, no recurrence or chronic pain was observed. This technique may be a feasible tissue-preserving option to facilitate posterior layer closure without TAR in selected patients, with preliminary outcomes.

Laparoscopic intraperitoneal onlay mesh repair with defect closure (intraperitoneal onlay mesh repair with fascial defect [IPOM Plus]) is widely practiced for ventral hernia repair but remains associated with significant postoperative pain and intraperitoneal mesh-related complications. Transabdominal preperitoneal mesh repair with defect closure (vTAPP Plus) offers an anatomical, extraperitoneal alternative that may reduce postoperative pain along with reduced mesh-related complications. High-quality randomized evidence directly comparing these techniques is limited. This prospective, single-center, randomized controlled trial was conducted at a tertiary care institute. Adults with small-to-medium primary ventral hernias (2-4 cm) were randomized to undergo laparoscopic IPOM Plus or vTAPP Plus repair. The primary outcome was mean postoperative pain score (Visual Analogue Scale [VAS]) within the first 24 hours. Secondary outcomes included serial pain scores up to 6 months, operative duration, length of hospital stay, postoperative complications, and recurrence. Statistical analysis was performed using appropriate statistical tests. In total, 68 patients were analyzed (IPOM Plus: n = 36; vTAPP Plus: n = 32). Baseline demographic and clinical variables were comparable between groups. vTAPP Plus demonstrated significantly lower postoperative pain at 6, 12, 24, and 48 hours, as well as at 14 and 30 days (P < .001). Differences diminished at 3 months and were not significant at 6 months. Operative time was marginally longer for vTAPP Plus, the hospital stay was significantly lower. Postoperative complication rates were comparable. No mesh infection or hernia recurrence was observed during follow-up. vTAPP Plus repair significantly reduces early and intermediate postoperative pain compared with IPOM Plus, without compromising safety or short-term efficacy. Thus, vTAPP Plus represents a better option for selected primary midline ventral hernias.

Incisional hernia (IH) is a common complication after colorectal cancer surgery that can impair quality of life and require reoperation. However, the anatomical distribution of IH according to surgical approach and the influence of patient-related factors on hernia morphology remain poorly characterized. We retrospectively analyzed patients who underwent elective colorectal cancer surgery between 2009 and 2022, and included in the analysis the 464 patients who met the eligibility criteria. Patients were grouped by surgical approach: laparoscopic, upper-midline incision, or lower-midline incision. IH was diagnosed on postoperative computed tomography (CT) during at least 3 years of follow-up. Using CT data, spatial distribution, hernia midpoint (mean of the superior and inferior fascial margins) and longitudinal length were analyzed. Associations with clinical factors-including age, BMI, diabetes mellitus (DM), and pathological stage-were assessed using univariate and multivariable linear regression. IH developed in 82 of 464 patients (18%). Density mapping demonstrated approach-specific spatial patterns: after upper-midline incisions, hernias clustered predominantly in the European Hernia Society M3 region, whereas hernias following lower-midline incisions were concentrated below the arcuate line in the M4 region. Hernia midpoint was not associated with patient factors, whereas hernia length was independently associated with DM and advanced tumor stage in lower-midline incisions. IH after colorectal cancer surgery shows approach-specific anatomical patterns reflecting regional abdominal wall vulnerability. These findings support anatomically guided risk stratification and may inform region-specific closure and prevention strategies.

ObjectivesIncisional hernia (IH) affects 13-30% of people after abdominal surgery, resulting in substantial morbidity and costs. While clinical risk factors have been studied extensively, genomic risk for IH is incompletely understood. We aimed to evaluate the impact of polygenic risk scores (PRS) on IH risk prediction.MethodsWe created and evaluated three PRS for abdominal hernia, ventral hernia and latent hernia susceptibility for prediction of IH in an institutional biobank. The primary outcome was defined as the diagnosis or repair of an IH based on ICD-9/10-CM/PCS and CPT codes. Clinical covariates included age, sex, body mass index (BMI), smoking status, index procedure type, and perioperative surgical site infection. A phenome-wide association study (PheWAS) was performed to assess clinical associations with increased PRS. We then tested the ability of the PRS to improve prediction for IH by modeling clinical covariates with and without PRS in patients who underwent abdominal surgery. Model performance was assessed using 10 iterations of 5-fold cross-validation to estimate Brier scores and area under the receiver operating characteristic curve (AUROC), which were compared using cross-model Bayesian analysis of variance.ResultsIn 55,809 subjects, assessed PRS was significantly associated with incisional, umbilical, and ventral hernia on PheWAS, with 1.19 greater odds of developing IH per 1-SD increase in PRS (95% CI: 1.13-1.25, P < 0.001). Of 9,909 subjects who underwent qualifying abdominal surgery, 706 developed IH. In this cohort, the latent hernia susceptibility PRS was associated with a 16% increased hazard of developing IH per 1-SD increase (HR 1.16; 95% CI: 1.07-1.26; P < 0.001). Compared to a predictive model using clinical covariates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC = 0.660, 95% CI: 0.653-0.666), addition of the PRS showed similar Brier score and AUROC estimates (Brier score = 0.047, 95% CI: 0.046-0.048; AUROC: 0.667, 95% CI: 0.661-0.673) at five years. Cross-model Bayesian analysis demonstrated >99% probability of practical equivalence when trying to detect a difference of ≥ 0.02.ConclusionAll three PRS for hernia were independently associated with IH, suggesting that genomic factors contribute significantly to IH development. However, none of the three PRS meaningfully improved clinical IH risk prediction in patients who underwent abdominal surgery. This suggests that clinical comorbidities and surgical techniques may be equally as important as genomic architecture.

Good preoperative information is associated with reduced anxiety and improved postoperative pain, satisfaction, and quality of life. In the present study, we assessed sex-based disparities in perceived sufficiency of perioperative information among patients undergoing ventral hernia repair. This study was part of the AFTERHERNIA Project, which included patients ≥18 years undergoing ventral hernia repair between January 2014 and March 2024. Patients identified via the Danish National Patient Register completed the Abdominal Hernia-Q, with responses linked to the Danish Ventral Hernia Database. Perceived sufficiency of perioperative information was assessed using three Abdominal Hernia-Q items: prepared for surgery, postoperative emotions, and recovery concerns. Multivariable analyses were adjusted for age, severe chronic pain, suspicion of recurrence, hernia characteristics, and surgical factors. Among 26,384 patients (10,108 females, 16,276 males; 79% [26,384 of 33,267] response rate), crude rates indicated that females were more often dissatisfied across all three items: prepared for surgery (14%vs9%), postoperative emotions (39%vs22%), and recovery concerns (34%vs22%). In adjusted analyses (n=23,201), females were also found to be more dissatisfied: prepared for surgery (OR 1.40;95%CI,1.28-1.53;P<0.001), postoperative emotions (OR 2.00;95%CI, 1.88-2.13;P<0.001), and recovery concerns (OR 1.61;95%CI,1.51-1.71;P<0.001). All three subgroup analyses showed similar patterns. Younger age, severe chronic pain, and suspicion of recurrence were independently associated with higher levels of dissatisfaction. These results show a possible sex-based disparity in perceived sufficiency of perioperative information, with higher dissatisfaction reported by females. These findings suggest that perioperative counselling may need to be tailored to better meet female patients' informational needs.