Incisional hernia remains a significant complication following abdominal surgery, with the incidence ranging from 5% to 20%. This systematic review compared the incidence of incisional hernia incidence between laparoscopic and open surgical approaches and identified effect modifiers. We searched PubMed, Cochrane Library, Embase, Web of Science, and SCOPUS for studies published from January 2000 to December 2023. This review was not registered in PROSPERO, representing a methodological limitation. Randomized controlled trials (RCTs) and observational studies comparing laparoscopic versus open surgery with a minimum 6-month follow-up were included. Risk of bias was assessed using Cochrane risk of bias 2.0 and Newcastle–Ottawa Scale. Random-effects meta-analysis calculated risk ratios (RR) with 95% confidence intervals (CI). Twenty-eight studies (15 RCTs, 13 observational) comprising 14, 567 patients were analyzed. Laparoscopic surgery demonstrated significantly lower incisional hernia risk (RR = 0.62, 95% CI: 0.51–0.75, P < 0.001; I2 = 45%). Benefits were consistent across colorectal (RR = 0.58), ventral hernia repair (RR = 0.55), and bariatric procedures (RR = 0.67). Meta-regression revealed stronger protective effects with higher body mass index (P = 0.03). Benefits persisted across follow-up periods and detection methods. Laparoscopic approaches significantly reduce incisional hernia risk across diverse abdominal procedures, with effects particularly pronounced in patients with obesity. These findings should inform surgical approach selection and patient counseling, though limitations include lack of protocol registration and limited representation of contemporary robotic techniques.
Incisional hernia represents one of the most common complications following abdominal surgery, occurring in 10%–20% of patients after midline laparotomy and imposing a substantial healthcare burden through reoperation costs, morbidity, and reduced quality of life. Despite being a frequent complication, incisional hernias are potentially preventable through evidence-based surgical techniques, patient optimization, and selective prophylactic mesh reinforcement. This narrative review synthesizes current evidence on strategies for preventing incisional hernia development, emphasizing preoperative risk stratification, technical aspects of fascial closure, the role of prophylactic mesh augmentation, and postoperative care optimization. A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases covering publications from 2000 to 2024, focusing on randomized controlled trials, systematic reviews, and high-quality observational studies. Patient-specific risk factors, including obesity, diabetes, smoking, chronic cough, immunosuppression, and malnutrition, substantially increase hernia risk and guide preventive strategy selection. Surgical technique factors, including suture material selection, suture-to-wound length ratio, stitch interval, and closure method, profoundly influence hernia incidence. The small bites technique using continuous, slowly absorbable monofilament suture with a suture-to-wound length ratio of at least 4:1 reduces incisional hernia rates by approximately 50% compared to traditional large-bite closures based on high-quality randomized controlled trials. Prophylactic mesh reinforcement in high-risk patients, particularly those undergoing abdominal aortic aneurysm repair or with multiple risk factors, demonstrates efficacy in reducing hernia incidence, though optimal patient selection, mesh type, and placement location remain areas requiring further investigation. This review acknowledges inherent limitations of narrative synthesis, including potential selection bias, heterogeneity in study populations and follow-up duration, and challenges in establishing definitive evidence hierarchies across diverse clinical contexts.
Obesity increases the risk of abdominal wall hernia (AWH). Body mass index (BMI) is widely used to define obesity, but it does not reflect fat distribution, especially visceral fat. Therefore, relying solely on BMI may be insufficient for assessing the relationship between obesity and AWH. This study examined the associations of visceral fat area (VFA) and waist circumference (WC) with AWH. A total of 417 participants were included in this study, including 209 patients with AWH and 208 healthy controls. VFA and WC were measured by bioelectrical impedance analysis. Multivariable logistic regression, smooth curve fitting, and subgroup analyses were used to evaluate the associations between VFA, WC, and AWH. Additionally, receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Compared with the controls, AWH patients had significantly higher VFA and WC (P < 0.001). After adjustment for potential confounders, both VFA and WC were strongly and positively associated with AWH risk, with evidence of nonlinear relationships. Subgroup analysis demonstrated that the correlation remained consistent across various populations (P-interraction > 0.05). ROC analysis indicated good diagnostic value for both indices (area under the curve: VFA = 0.726; WC = 0.727). Our findings that increased VFA and WC are associated with a higher risk of AWH contribute to our understanding of the relationship between visceral fat distribution and AWH. This finding further supports that keeping VFA and WC within healthy ranges may help prevent AWH. However, inference is limited by the cross-sectional, single-center design and incomplete data on hernia type, defect size, and certain risk factors. Confirmation in multi-center prospective cohorts is needed.
Diastasis recti abdominis (DRA) is characterized by a widened linea alba, but its pathophysiology may involve complex biomechanical failure. This pilot study utilized shear-wave elastography (SWE) to characterize the mechanical properties of the abdominal wall in healthy adults and investigate the influence of obesity on DRA presentation. The study was conducted on a group of 10 healthy adult volunteers. All participants underwent ultrasonographic assessment. Morphological measurements and SWE of the linea alba, rectus sheaths, and lateral fasciae were performed at rest and during three maneuvers: Valsalva, curl-up, and side plank. Four participants had DRA. A divergent biomechanical response was observed: during an isolated curl-up, the linea alba stiffened in obese individuals with DRA but softened in non-obese individuals. A visible epigastric bulge was universally linked to DRA, but its manifestation depended on body habitus and the type of muscle activation. Obese individuals exhibited bulging during global maneuvers (Valsalva, side plank), whereas non-obese individuals showed bulging only during the curl-up. Obesity fundamentally alters the abdominal wall's response to load, suggesting a dual pathophysiology for DRA-related bulging. These preliminary findings highlight that management strategies, including physical therapy, may need to be tailored based on patient body habitus.
Inguinal hernia associated with disorders of sex development (DSD) is uncommon, and an occurrence further complicated by Sertoli–Leydig cell tumors (SLCTs) is exceedingly rare. A woman underwent surgery for recurrent inguinal hernia. Intraoperatively, the hernia sac contents were identified as adnexal tissue. Postoperative pathological examination revealed a 46, XY DSD with SLCTs. Although rare, hernia surgeons should maintain awareness of these conditions.
In our institution, an open (groin incision) approach is selected for emergency surgery for an incarcerated inguinal hernia. However, a laparoscopic approach may also be recommended for some cases to confirm the viability of the strangulated organ and assess the condition of the whole abdominal cavity. Laparoscopy through the inguinal hernia sac is known as hernioscopy. We herein report a case of an incarcerated inguinal hernia that underwent hernioscopy with the single-incision laparoscopic surgery (SILS) technique during emergency surgery. By using forceps in the abdominal cavity during hernioscopy, we were able to safely confirm the viability of the strangulated organ. Hernioscopy with the SILS technique has potential as a useful surgical option for incarcerated inguinal hernia surgery.
Inguinal bladder hernias (IBHs) are relatively rare, and patients often present with urinary discomfort. Early recognition of bladder involvement in inguinal hernias is critical to prevent iatrogenic bladder injury and associated complications. Here, we report a case of urinary tract infection secondary to an IBH, which was successfully repaired surgically, with an uneventful postoperative recovery. This report highlights the diagnostic and therapeutic strategies for managing IBH. Clinicians should maintain a high index of suspicion for bladder involvement in patients presenting with both lower urinary tract symptoms and an inguinal mass.