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

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.

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

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.

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.

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.

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.

To evaluate hernia recurrence,postoperative complications,and patient reported outcomes after combined open ventral hernia repair(OVHR)and rectus diast asis(RD)reconstruction with abdominal wall contour correction in postpartum women. This retrospective study included women (BMI < 30kg/m2) with symptomatic ventral hernia ≥ 1cm and concomitant RD ≥ 3cm who underwent elective combined repair between 2018 and 2024. All patients had completed childbearing, experienced functional complaints, and maximized physiotherapy benefit. Primary outcomes were hernia recurrence and postoperative complications, classified as surgical site occurrences (SSO) and SSO requiring procedural intervention. Secondary outcomes included functional, physical, and cosmetic patient-reported outcomes. Fifty-nine patients were included. Wound-related complications occurred in 38.9%,mainly wound dehiscence (18.6%) and umbilical necrosis (13.6%).Wound infection occurred in5.1%, with 3.4% requiring radiologic drainage and1.7%reoperation. Significant postoperative improvements were observed in abdominal pain (93.2% to 15.3%, p < 0.001), back pain (64.4% to3.4%, p < 0.001) abdominal swelling (59.3% to5.1%, p < 0.001), abdominal wall dysfunction (100% to8.5%, p < 0.001), and physical limitations (61.0% to 0%, p < 0.001). Dissatisfaction with abdominal aesthetics decreased from 100% preoperatively to 18.6% postoperatively (p < 0.001). No hernia recurrence occured. Combined OVHR and RD reconstruction in postpartum women results in substantial improvements in pain, function, and abdominal wall aesthetics without hernia recurrence. Despite notable wound-related complications, outcomes support the functional and quality-of-life benefits of a multidisciplinary surgical approach. Prospective studies are needed to confirm these findings and optimize perioperative strategies.

Surgical Technique for Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES) Sacrocolpopexy.

Extended-view totally extraperitoneal repair (eTEP) is one of the recently introduced, advanced minimal access approaches for the repair of ventral hernias. Posterior sheath rupture (PRSR), though rare, is a lethal complication of eTEP, exposing the polypropylene mesh to the viscera. Few cases of PRSR have been reported following eTEP ventral hernia; however, delayed presentations as acute small bowel obstruction, has not been reported so far. We present the case of acute intestinal obstruction following eTEP ventral hernia repair after 10 months following the primary surgery. A 67-year-old female underwent laparoscopic eTEP repair for an incisional hernia using a polypropylene mesh of 20 cm × 15 cm without mesh fixation, along with anterior and posterior rectus sheath re-approximation 10 months ago. She presented in emergency with abdominal pain and constipation and obstipation for 2 days. Contrast-enhanced computed tomography of the abdomen and pelvis revealed interstitial hernia with dilated small bowel herniating till anterior rectus sheath with adhesions to the mesh through the posterior rectus sheath dehiscence. She was subjected for an emergency laparoscopic surgery. She had an uneventful recovery. Ventral hernia repair with mesh reinforcement in retrorectus plane is considered safer with maintained peritoneal integrity, reducing the risk of bowel obstruction and fistula formation as with an intraperitoneal mesh. There are few documented cases of posterior rectus sheath rupture as an early complication of eTEP, which exposes to similar risks of bowel obstructions. However, PRS rupture as delayed complication with bowel obstructions has not been documented. A high degree of clinical suspicion of PRS rupture must be kept post-ventral hernia repair in patients presenting with obstructive symptoms. We consider that poor muscle tone, strenuous activity and deep bending may cause PRS rupture.

Obesity is considered as a risk factor for postoperative complications after ventral hernia repair (VHR). While promising results of robotic VHR in patients with obesity have been demonstrated, outcomes stratified across BMI categories in patients undergoing robotic transversus abdominis release (rTAR) remain limited. In this multicenter study, we compared perioperative and long-term outcomes after rTAR in patients without obesity (BMI < 30kg/m2), patients with class I obesity (30-34.9kg/m2), and patients with class II obesity (35-39.9kg/m2). We performed a retrospective cohort analysis of consecutive rTAR patients at five centers between February 2015 and July 2025. The primary outcome was overall complication rates; secondary outcomes included surgical site events (SSEs), including occurrences (SSOs), infections (SSIs), and hernia recurrences. Outcomes were analyzed using univariate tests. Multivariate logistic regression tests were run to identify independent risk factors. A total of 343 patients included in this study; 160 (46.6%) were patients without obesity, 117 (34.1%) patients had class I obesity, and 66 (19.2%) patients had class II obesity. Overall complication rates were comparable across groups (31.1% vs 27.6% vs 30.3%, p = 0.818). No significant differences observed in length of hospital stay, 30-day readmissions, Clavien-Dindo grades, Comprehensive Complication Index scores, or SSEs, including SSOs and SSIs. Hernia recurrence occurred in one patient per group. Multivariate analysis demonstrated that BMI category was not an independent predictor of complications. Independent risk factors for any postoperative complication included COPD (OR 3.45, 95% CI 1.58-7.11), prior wound infection (OR 2.22, 95% CI 1.19-4.11), non-use of the TEP approach (OR 1.94, 95% CI 1.10-3.43), bilateral TAR (OR 2.58, 95% CI 1.27-5.22), prolonged adhesiolysis > 30min (OR 1.77, 95% CI 1.01-3.08), and lack of primary defect closure (OR 5.67, 95% CI 1.37-23.47). For SSEs specifically, COPD (OR 2.43, 95% CI 1.10-5.37), prior wound infection (OR 2.17, 95% CI 1.10-4.28), prolonged adhesiolysis (OR 1.96, 95% CI 1.09-3.52), and lack of primary defect closure (OR 4.78, 95% CI 1.36-16.78) were independent predictors. Comparable short- and long-term outcomes were observed with rTAR across patients without obesity, with class I obesity, and with class II obesity. Surgeons may need to consider comorbidities, particularly COPD and prior wound infection history, alongside operative factors such as TEP access, primary defect closure, and the careful application of bilateral TAR, in order to optimize patient outcomes.

Mesh reinforcement is standard in ventral hernia repair, but the optimal anatomical mesh placement remains debated. To compare the risk of reoperation for recurrence and bowel obstruction across different mesh placements after elective primary ventral hernia repair. This Danish nationwide register-based cohort study included adults (age ≥18 years) who underwent elective primary (umbilical or epigastric) ventral hernia repair with mesh for hernia defects 10 cm or smaller between January 2014 and April 2025, with follow-up through November 1, 2025. Patients were identified in the Danish National Patient Register, with data linked to the Danish Ventral Hernia Database and the Danish Civil Registration System. Data were analyzed from November 2025 through January 2026. Mesh placement technique: onlay, retromuscular, preperitoneal, or intraperitoneal onlay mesh (IPOM). The primary outcomes were reoperation for recurrence and bowel obstruction, with data presented as estimated hazard ratios (HRs) from Cox proportional hazards regression models. A total of 17 832 patients were included: 8764 with onlay mesh placement, 1239 with retromuscular mesh placement, 4292 with preperitoneal mesh placement, and 3537 with IPOM. Mean (SD) patient age was 54 (13.5) years, and 4873 patients (27.3%) were female. Compared with onlay mesh placement, both retromuscular mesh placement and IPOM were associated with an increased risk of reoperation for recurrence (HR, 1.63; 95% CI, 1.12-2.38; and HR, 1.38; 95% CI, 1.02-1.86, respectively). The risk of bowel obstruction was also higher after retromuscular and IPOM placement compared with onlay (HR, 2.01; 95% CI, 1.05-3.82; and HR, 3.47; 95% CI, 2.27-5.28, respectively). In this nationwide register-based cohort study, retromuscular mesh placement and IPOM were associated with a higher risk of reoperation for recurrence and bowel obstruction compared with onlay mesh placement. When considering the risks of recurrence and bowel obstruction, onlay and preperitoneal mesh placement may be preferable options for primary ventral hernia repair.

To review the renal consequences of complex abdominal wall reconstruction (AWR) and examine how reconstructive mechanics, intra-abdominal pressure, perioperative fluid strategy, and baseline renal reserve influence postoperative kidney outcomes. This focused narrative review searched PubMed/MEDLINE and Embase for studies published through March 2026 using terms related to abdominal wall reconstruction, complex ventral hernia repair, loss of domain, component separation, transversus abdominis release, intra-abdominal pressure, abdominal compartment syndrome, acute kidney injury, chronic kidney disease, renal dysfunction, and perioperative renal outcomes. Reference lists of key studies were also screened manually. Postoperative acute kidney injury after complex AWR is not uncommon and appears to cluster in patients with greater reconstructive intensity, particularly those undergoing large ventral hernia repair, major visceral reintegration, or transversus abdominis release. The available literature supports a clinically useful framework in which renal vulnerability after AWR reflects the interaction of pressure-related stress, hemodynamic and fluid-related factors, and limited baseline renal reserve. In selected patients, postoperative kidney injury may extend beyond the index admission. Complex AWR should be understood not only as an anatomic reconstruction but also as a physiologically demanding operation in which renal dysfunction may signal meaningful perioperative stress. For abdominal wall surgeons, this perspective supports more deliberate interpretation of postoperative oliguria, greater awareness of pressure-mediated organ dysfunction, and closer renal follow-up in high-risk patients.

Mesh repair reduces recurrence risk, but evidence regarding patient-reported outcomes (PROs) across mesh placements remains limited. This study aimed to investigate the association between mesh placement and PROs in primary ventral hernia repair, and secondarily the prevalence of severe chronic pain and foreign body sensation. This nationwide survey- and register-based study, part of the AFTERHERNIA project in Denmark, linked electronic survey responses with operative data from the Danish Ventral Hernia Database. Adults (≥ 18years) who underwent elective primary (umbilical or epigastric) ventral hernia repair with mesh between January 1, 2014, and March 31, 2024, were included, limited to defects < 10cm. PROs were assessed using the validated, ventral hernia-specific Abdominal Hernia-Q (AHQ) questionnaire. Out of 13,327 eligible patients, 10,869 (82%) responded (median age, 54years; 71% male). Compared with onlay, preperitoneal repair had a better AHQ sum score (58.7 vs 57.7; mean difference, 0.9; 95% CI, 0.6 to 1.2; P < .001), lower prevalence of severe chronic pain (8.7% vs 11.3%; difference, -2.6%; 95% CI, -4.0% to -1.2%; P < .001), and lower prevalence of foreign body sensation (20.1% vs 23.9%; difference, -3.8%; 95% CI, -5.7% to -1.8%; P < .001). Findings were consistent across subgroups and sensitivity analyses. PROs were generally good across mesh placements. Preperitoneal mesh placement was associated with slightly better PROs compared with other placements, although the difference was small and unlikely to be clinically meaningful. However, it was associated with a lower prevalence of severe chronic pain and foreign body sensation compared with onlay and intraperitoneal mesh.

The adequate follow-up (FU) of patients undergoing ventral hernia repair (VHR) is crucial for both detecting recurrence and addressing health disparities. Loss to FU can significantly affect clinical outcomes, as it hinders timely interventions and long-term monitoring. Factors such as demographic characteristics, comorbidities, socioeconomic status, and access to care may all influence the likelihood of loss of FU. We aimed to provide a time-dependent analysis of factors associated with the time of postoperative FU and factors influencing FU loss in a specialized hernia center. Patients who underwent VHR between 2021 and 2023 were identified through medical chart review. Demographic, geographical, and clinical data were collected. FU was defined as days from surgery to the last office visit, and loss of FU was defined as failure to attend two consecutive scheduled clinic visits with no documented clinical contact for more than 6 months after the last visit. As a surrogate for social, financial, and geographical factors, the Distressed Communities Index (DCI) was used based on patients' ZIP codes. A Cox proportional hazards regression was used to analyze time-to-event data. Variables were selected based on clinical relevance as an exploratory analysis, including the DCI, out-of-city residency, sex, age, hospital length of stay (LOS), race, psychological diagnosis type of hernia, approach (robotic versus open), transversus abdominis release (TAR), hernia size, concomitant procedures, mesh use, postoperative emergency visits and reoperation, surgical site infection (SSI), surgical site occurrences (SSO), recurrence, chronic pain. Model assumptions were assessed, including proportional hazards. Hazard ratios (HR) and 95% confidence intervals (CI) were computed, and statistical significance was assessed using Wald tests. Model performance was evaluated with the concordance index (C-index). Kaplan Meier curves were built for factors identified as relevant for FU loss. All analyses were conducted using R. This study analyzed 264 ventral hernia repair patients (2021-2023; median age 56, BMI 30.3) to identify factors associated with post-operative FU loss. Baseline characteristics included 39.4% recurrent hernias and 22.7% with psychiatric conditions. Postoperative complications were low, but FU significantly declined over time (e.g., 53.0% at 1 year, 12.1% at 3 years). Unadjusted analyses showed open surgical approach, in-city residency, lower DCI, and a prior psychiatric diagnosis were associated with better FU. Multivariable Cox regression revealed that increased age reduced FU loss (HR 0.97). Geographic factors significantly impacted FU, with out-of-city residency (HR 1.82) and higher DCI (HR 1.74) both independently associated with increased FU discontinuation. Our findings suggest that the geographical, social, and financial factors represented by the DCI significantly influence the risk of the event. In addition, increased age was associated with reduced risk of FU loss, whereas out-of-city residency and higher DCI were associated with increased risk of FU discontinuation.

Ventral hernias are frequently encountered in patients undergoing gastrointestinal (GI) cancer surgery, creating a clinical dilemma regarding whether to perform concomitant ventral hernia repair (VHR) during oncologic resection. While mesh-based repair reduces recurrence in elective settings, its use in potentially contaminated fields remains controversial due to concerns regarding surgical site infection (SSI), reoperation, and impaired recovery in a vulnerable oncologic population. Therefore, this systematic review aims to evaluate the perioperative outcomes regarding concomitant VHR during GI cancer surgery. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and the Cochrane Handbook. PubMed, Embase, Cochrane Library, and Scopus were searched from inception to October 2025. Studies including adult patients undergoing simultaneous VHR (with or without mesh) during GI cancer surgery were eligible. Primary outcomes included SSI, reoperation, length of hospital stay (LOS), recurrence, and postoperative mortality. Risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomized Studies of Interventions-I tool. Due to substantial clinical and methodological heterogeneity, meta-analysis was not performed, and findings were synthesized descriptively. Eight observational studies were included. A total sample of 11,141 patients was studied, with 4566 patients with a diagnosed neoplasm undergoing surgery. Out of these, most procedures involved colorectal malignancies (n = 3695; 80.9%) and were performed electively (86.7%) via an open approach. Thirty-day mortality rates were consistently low (0-3.4%) and comparable between mesh and no-mesh groups. SSI rates varied widely (5.6-21.7%), with inconsistent differences between cohorts. Reoperation rates ranged from 0% to 27%, and LOS varied from approximately 3 to 11 days. Hernia recurrence, when reported, reached up to 40% in studies with longer follow-ups. Considerable heterogeneity was observed in cancer type, contamination level, mesh material and placement, use of component separation, and follow-up duration. All studies were judged to have a moderate risk of bias, primarily due to confounding and nonrandomized design. Concomitant VHR during GI cancer surgery appears feasible and is not associated with increased short-term mortality. However, variability in SSI, reoperation, and recurrence rates underscores the complexity of patient selection and operative decision-making in oncologic populations. Given the heterogeneity and moderate risk of bias of available evidence, prospective multicenter studies with standardized reporting are needed to better define optimal reconstructive strategies and risk-stratified treatment algorithms.

Whether ventral or incisional hernias should be repaired during abdominoplasty remains disputed. A PROSPERO-registered PRISMA-2020 systematic review searched PubMed, Scopus, and Cochrane on June 15, 2025. Twenty-four studies (2 randomised trials, 2 propensity-matched registry analyses, 19 cohort series and 1 case report) encompassed 3142 adults, 1456 of whom underwent a single-stage repair, were included. Primary outcomes analysed were surgical-site occurrence (SSO), hernia recurrence, reoperation and patient-reported measures. Median SSO after combined repair was 20% (range 0-51 %), an absolute increase of 7-8 % versus abdominoplasty alone; most events were minor seromas or superficial infections. The 30-day readmission rate was ≤ 3%, and the unplanned reoperation rate was approximately 6%, similar to the rate for abdominoplasty alone. Durability was excellent: 21 recurrences (1.4%) occurred at a median 23-month follow-up, and neither randomised trial showed excess failure. Propensity-matched analyses likewise revealed no uptick in severe morbidity. Validated instruments demonstrated substantial gains in physical function (SF-36 + 25), body-image distress (DAS-24-16 to -33) and overall satisfaction (> 90%). Contemporary evidence suggests that simultaneous abdominoplasty and ventral/incisional hernia repair delivers durable closure and substantial functional and cosmetic benefits, while adding only a modest, largely minor increase in wound morbidity. For patients with a BMI < 35 kg/m2 and well-controlled comorbidities, a single-stage approach appears safe, efficient, and patient-centred, when performed with perforator-sparing dissection, judicious mesh use and vigilant postoperative care. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .