Hernia最新文献

Objective: To evaluate the differences in quality of life at 5 years postoperatively between laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein tension-free repair for adult patients with primary unilateral inguinal hernia, with a primary focus on EuraHS-QoL scale scores and an exploration of long-term outcomes including chronic postoperative pain, recurrence rates, functional recovery, and patient satisfaction.

Methods: This was a single-center retrospective cohort analysis. Adult patients who underwent TAPP or Lichtenstein repair for primary unilateral inguinal hernia between January 2015 and December 2020 were included. Patients were categorized into a TAPP group (n = 300) and a Lichtenstein group (n = 200) based on the surgical approach. The primary outcome was the quality of life score at 5 years postoperatively, assessed using the EuraHS-QoL scale across three domains: pain, activity restriction, and cosmetic appearance. Secondary outcomes included the incidence of chronic postoperative pain, hernia recurrence rate, postoperative complications, time to functional recovery (e.g., return to daily activities and work), and subjective satisfaction. Multivariate regression models were used to control for confounding factors, and sensitivity analysis was performed using propensity score matching (PSM).

Results: The median follow-up duration was 62 months (IQR: 60-66). The TAPP group demonstrated a significantly better total EuraHS-QoL score [median 2.0 (IQR: 1.0-4.0)] compared to the Lichtenstein group [median 3.0 (IQR: 2.0-5.0)] (P < 0.001), with particularly pronounced differences in the activity restriction and cosmetic appearance domains (P < 0.01). The TAPP group had a lower incidence of chronic postoperative pain (12.0% vs. 20.5%, P = 0.006), faster functional recovery (time to return to daily activities: 6 days vs. 8 days, P < 0.001), and higher satisfaction scores (8.8 ± 1.1 vs. 7.9 ± 1.4, P < 0.001). No statistically significant differences were observed between the two groups in recurrence rates or overall complication rates. The findings remained consistent after multivariate regression and PSM analysis.

Conclusion: In this retrospective analysis, both TAPP and Lichtenstein repair provided favorable long-term quality of life. While initial unadjusted comparisons suggested a total score advantage for TAPP, this was not maintained in the matched sensitivity analysis. TAPP demonstrated benefits in reduced chronic pain and faster functional recovery, without increasing recurrence. These findings support the consideration of TAPP as a viable option in suitable patients, though they should be interpreted in light of the study's retrospective design and require prospective validation.

Introduction: Hernias are among the most common surgical conditions worldwide. However, access to optimal treatment remains disproportionately distributed. Socioeconomic disparities play a critical role in determining whether patients receive timely surgical intervention, access to minimally invasive techniques, or suffer from postoperative complications due to delayed or suboptimal care. This study aims to evaluate the impact of socioeconomic disparities on the treatment of ventral hernia repair.

Methods: This systematic review was conducted following PRISMA guidelines. A comprehensive search was conducted using MEDLINE/Pubmed, EMBASE, Web of Science, Cochrane Library, and LILACS, from inception until March 2026 without any filter applied. A search strategy was created using the MeSH terms. Our inclusion criteria comprise studies related to socioeconomic disparities in ventral hernia repair within the United States. Due to heterogeneity in study designs, socioeconomic variables, and outcome definitions, a meta-analysis was not feasible, and findings were synthesized using a narrative synthesis. A qualitative assessment of included studies was made using the Cochrane Risk of Bias tool, ROBINS-I.

Results: A total of 28 studies were included, encompassing 2,096,513 patients with ventral hernia. Most were retrospective cohorts, with sample sizes ranging from a few hundred to over 665,000 patients. Across studies, patients with government funded insurance (Medicaid or Medicare) generally experienced higher rates of complications, readmissions, and recurrences compared to commercial insured patients, although the magnitude of association varied. Odds ratios demonstrated increased risks of wound complications, readmission, and recurrence among government funded insured and uninsured patients, while commercial insured and higher-income patients were more likely to undergo advanced surgical approaches and had shorter hospital length of stay. Some studies also highlighted socioeconomic and racial disparities, with vulnerable populations and minority groups showing disproportionately higher complication rates and different patterns of insurance coverage.

Conclusion: This systematic study demonstrates significant racial and socioeconomic disparities in ventral hernia repair. Government funded insurance holders or lower incomers, faced higher complication rates, more emergent presentations, and worse outcomes, including increased mortality and readmissions. Moreover, they usually have less access to minimally invasive and robotic techniques. These inequities highlight systemic barriers in healthcare access.