Ahmed Usamah, Rosenberg Jacob, Baig Sarfaraz Jalil, Wijerathne Sujith, Yang Wah, Li Shuqing, Baker Jason Joe
Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, Herlev, DK-2730, Denmark.
Digestive Surgery Clinic, 7B, St Francis Xavier Sarani, Mullick Bazar, Park Street area, Kolkata, 700017, West Bengal, India.
Hernia. 2025 Sep 9;29(1):273. doi: 10.1007/s10029-025-03429-1.
Primary ventral hernia repair is a common elective procedure; however, mesh placement practices vary widely, and there is limited evidence to guide optimal placement. This international study examined surgeons' preferences and considerations regarding mesh placement in elective primary ventral hernia repair.
We conducted an international cross-sectional survey targeting surgeons experienced in primary ventral hernia repair. The survey was distributed through hernia societies and social media platforms. It included 31 questions addressing surgeon demographics and their beliefs on various mesh placements. Data were collected using REDCap, Google Forms, and Questionstar.
A total of 442 surgeons participated, with the majority being specialist surgeons (96%) who had performed at least 100 repairs (82%). Inlay was the least familiar mesh technique (26%). For hernia defects < 1 cm, preperitoneal (28%) and suture-only repair (27%) were considered to yield the best overall outcomes. For defects ≥ 1 to ≤ 4 cm, preperitoneal and retromuscular techniques were equally favored (34%), whereas retromuscular was regarded as the best option for larger defects (> 4 to 9 cm; 68%). Laparoscopic and robotic-assisted approaches were increasingly preferred for larger defect sizes. Hernia defect size (93%), surgical history (90%), and obesity (80%) were the most common factors influencing the choice of mesh placement.
Preperitoneal and suture-only repairs were most commonly selected for hernia defects < 1 cm, while preperitoneal and retromuscular placements were equally favored for defects ≥ 1 to ≤ 4 cm. For defects > 4 to 9 cm, retromuscular placement was selected by most surgeons. As defect width increased, laparoscopic and robot-assisted approaches gained preference. Key factors influencing decisions included hernia defect size, surgical history, and obesity. The lack of strong supporting evidence highlights the need for further high-quality research.
原发性腹疝修补术是一种常见的择期手术；然而，补片放置方法差异很大，且指导最佳放置的证据有限。这项国际研究调查了外科医生在择期原发性腹疝修补术中对补片放置的偏好和考虑因素。
我们针对有原发性腹疝修补经验的外科医生开展了一项国际横断面调查。该调查通过疝病学会和社交媒体平台进行分发。它包括31个问题，涉及外科医生的人口统计学信息以及他们对各种补片放置方法的看法。数据通过REDCap、谷歌表单和问卷星收集。
共有442名外科医生参与，其中大多数是专科外科医生（96%），且至少进行过100例修补手术（82%）。内置法是最不熟悉的补片技术（26%）。对于疝缺损＜1cm的情况，腹膜前修补（28%）和单纯缝合修补（27%）被认为总体效果最佳。对于≥1cm至≤4cm的缺损，腹膜前和肌后技术同样受到青睐（34%），而肌后技术被视为较大缺损（＞4cm至9cm；68%）的最佳选择。对于较大的缺损尺寸，腹腔镜和机器人辅助手术方法越来越受到青睐。疝缺损大小（93%）、手术史（90%）和肥胖（80%）是影响补片放置选择的最常见因素。
对于疝缺损＜1cm的情况，最常选择腹膜前修补和单纯缝合修补，而对于≥1cm至≤4cm的缺损，腹膜前和肌后放置同样受到青睐。对于＞4cm至9cm的缺损，大多数外科医生选择肌后放置。随着缺损宽度增加，腹腔镜和机器人辅助手术方法更受青睐。影响决策的关键因素包括疝缺损大小、手术史和肥胖。缺乏有力的支持证据凸显了进一步开展高质量研究的必要性。
