Driven by the policies of government to promote day surgery, inguinal hernia day surgery has developed rapidly in China, yielding significant social and economic benefits. However, due to the vast territory and considerable regional disparities in China, the technical and management development of day surgery remains highly uneven. To effectively evaluate the outcomes and ensure quality control of inguinal hernia day surgery, and to facilitate its further nationwide promotion, the Hernia and Abdominal Wall Ambulatory Surgery Expert Group of China Ambulatory Surgery Alliance, in collaboration with relevant institutions, organized domestic experts in hernia and abdominal wall surgery day surgery. Based on literature and the practical situation of its domestic promotion, they developed the Expert guideline on standardized process and standards of ambulatory surgery for inguinal hernia (2026 edition), aiming to provide a better reference and foundation for establishing standardized and uniform procedures for inguinal hernia day surgery.

Hernia is a common disease in general surgery, and surgical repair remains the only curative treatment at present. To restore the structural integrity and functional stability of the abdominal wall, hernia repair procedures usually require the implantation of mesh for reconstruction. With the continuous development of materials science and engineering technology, hernia repair materials have become increasingly diverse in type and structure, exhibiting notable differences in mechanical properties, biocompatibility, and clinical indications; however, the ideal repair material remains to be further explored. The promotion of the ambulatoryhernia surgery model has imposed higher requirements on hernia repair materials. This article systematically reviews the development history and current research status of hernia repair materials, with a focus on commonly used mesh types and their clinical application characteristics. In addition, in light of recent trends in material design, the future development directions are analyzed, with the aim of providing a reference for the rational selection of hernia repair materials and for related research.

To summarize the ultrasound images and clinical features of aggressive fibromatosis of the abdominal wall, and to improve the understanding of the disease by clinicians and sonographers.

The ultrasound images of 10 patients with aggressive fibromatosis of the abdominal wall diagnosed by pathology in Peking Union Medical College Hospital from January 2018 to November 2025 were retrospectively analyzed, and the characteristics of ultrasound images were summarized.

The ages of the 10 patients with aggressive fibromatosis of the abdominal wall ranged from 29 to 64 years (median age 34.5 years), including 9 female patients and 1 male patient. All 10 patients had single lesions and all occurred in the muscular layer of the abdominal wall. The ultrasound manifestations were mainly hypoechoic (10/10 cases, 100%), parallel growth along the muscular layer (10/10 cases, 100%), infiltrative growth along the horizontal direction of the muscular layer (7/10 cases, 70%), clear lesion boundaries in the direction perpendicular to the muscular layer (10/10 cases, 100%), and uneven internal echoes (9/10 cases, 90%). No calcification or liquid dark areas were observed internally (10/10 cases, 100%).

Aggressive fibromatosis of the abdominal wall has certain characteristics on ultrasound images. Sonographers should combine clinical manifestations and ultrasound characteristics to distinguish it from other masses of the abdominal wall.

To evaluate the clinical value of multi-slice spiral CT (MSCT) imaging features and high-frequency ultrasound in differentiating indirect and direct inguinal hernias in adults.

Clinical data of 125 patients presenting with an inguinal mass and admitted to Yulin Hospital of Traditional Chinese Medicine between January 2020 and December 2024 were retrospectively analyzed. All patients underwent laparoscopic hernia repair. Intraoperative findings during laparoscopic exploration were used as the reference standard. All patients received MSCT and high-frequency ultrasonography. The diagnostic performance of MSCT and high-frequency ultrasonography for inguinal hernia was evaluated, as well as their performance in diagnosing indirect and direct inguinal hernias. MSCT location characteristics and imaging signs, high-frequency ultrasonographic findings, and the detection of hernia contents were compared between indirect and direct inguinal hernias.

The sensitivity and specificity of MSCT in diagnosing inguinal hernias were 97.79% and 80.00%, respectively, with a kappa value of 0.652. The sensitivity and specificity of high-frequency ultrasound in diagnosing inguinal hernias were 96.32% and 80.00%, respectively, with a kappa value of 0.551. For the diagnosis of indirect hernias, MSCT had a sensitivity of 97.00% and a specificity of 94.44%, with a kappa value of 0.906; for the diagnosis of direct hernias, MSCT had a sensitivity of 94.44% and a specificity of 97.00%, with a kappa value of 0.906. High-frequency ultrasound had a sensitivity of 92.00% and a specificity of 88.89% for diagnosing indirect hernias, with a kappa value of 0.781, and a sensitivity of 88.89% and a specificity of 92.00% for diagnosing direct hernias, with a kappa value of 0.781. Indirect inguinal hernias presented with mixed density or were cystic-solid, all distributed on the anterior side of the inguinal ligament and lateral to the inferior epigastric artery, without a crescent sign or filling of the femoral triangle. Direct hernias were all distributed on the anterior side of the inguinal ligament and medial to the inferior epigastric artery, without filling of the femoral triangle, and often with a lateral crescent sign. The indirect hernia sac was located lateral to the origin of the inferior epigastric artery, and the diameter and shape of the hernia ring varied greatly. The direct hernia sac was located medial to the inferior epigastric artery, with no significant changes in the local abdominal wall, clear intestinal wall layers, no obvious hernia sac neck, and a small amount of fluid dark area could be detected in the hernia sac cavity of some patients. The hernia ring was located medial to the inferior epigastric vessels, and there was a small amount of color blood flow signal in the intestinal wall. The proportions of contents in indirect hernias were, in descending order: intestinal canal, greater omentum, ovary, effusion, intra-abdominal fat, and bladder. The proportions of contents in direct hernias were, in descending order: intestinal canal, intra-abdominal fat, greater omentum, effusion, ovary, fat, and bladder. After Bonferroni correction (corrected significance level of P<0.0083), there were no statistically significant differences in the detection rates of all contents between the two groups (all P>0.0083).

Both MSCT imaging features and high-frequency ultrasound have important clinical value in differentiating indirect and direct inguinal hernias in adults. MSCT can provide a basis for the classification of inguinal hernias by confirming the presence of specific imaging signs and combining the relationship between the hernia sac neck and the inferior epigastric artery. High-frequency ultrasound can dynamically assess the reducibility of hernia contents in real time, which is of great guiding significance for clinical classification.

To evaluate the safety and feasibility of ambulatory inguinal hernia repair in patients with inguinal hernia complicated by liver cirrhosis and mild to moderate ascites (IH-LC-MA) under strict patient selection and standardized perioperative management, and to summarize key management strategies.

A retrospective analysis was conducted on IH-LC-MA patients who underwent inguinal hernia repair and were managed under an ambulatory surgery pathway in the Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University between June 2023 and June 2025. Baseline characteristics, perioperative parameters, length of hospital stay, postoperative complications, and follow-up outcomes were collected and analyzed.

A total of 14 patients were included, all of whom were male, with a median age of 62.5 (range: 33.0 to 77.0) years old. Six patients were classified as Child-Pugh grade A and eight as grade B. The median depth of the largest fluid-dark zone in ascites prior to surgery was 3.8 (range: 1.6 to 8.5) cm. All patients underwent Lichtenstein hernia repair under local nerve block anesthesia successfully. Median operative time was 60 (range: 30 to 80) minutes, with median intraoperative blood loss of 5.0 (range: 2.0 to 15.0) ml. All patients were discharged within 48 hours, including 11 within ≤24 hours and 3 between >24 hours and ≤48 hours. The median follow-up time was 14 ( range: 7 to 29) months. During the follow-up period, five patients developed postoperative seromas, all of which resolved spontaneously without specific intervention. No serious complications were observed, including incisional infection, seroma leakage, chronic pain, hernia recurrence, hepatic encephalopathy, or major gastrointestinal hemorrhage. Overall patient satisfaction reached 100%.

With rigorous preoperative assessment and preparation, individualized anesthesia and surgical planning, and meticulous postoperative management, ambulatory surgery for patients with IH-LC-MA is a safe and viable mode.

To analyze the safety of performing Lichtenstein repair under local anesthesia in an ambulatory (day-case) surgery setting for patients with inguinal hernia who are on a single antiplatelet medication.

A retrospective analysis was conducted on 1986 patients who underwent day-case Lichtenstein repair under local anesthesia for inguinal hernia at Beijing Chaoyang Hospital, Capital Medical University, between January 2023 and June 2025. Patients were divided into an observation group (178 cases) receiving a single antiplatelet agent (aspirin or clopidogrel) and a control group (1808 cases) not on such medication. The two groups were compared regarding general patient data, hernia type, operative time, time to ambulation, postoperative pain scores, and the incidence of complications (including hematoma, seroma, wound infection, inguinal region pain, recurrence, and deep vein thrombosis) at follow-up visits of 1 week, 1 month, and 3 months postoperatively.

There were no statistically significant differences between the two groups in baseline characteristics such as gender, age, body mass index, operative time, and length of hospital stay(P>0.05). Furthermore, at all follow-up time points (1 week, 1 month, 3 months), no statistically significant differences were observed in the incidence of complications including incision infection, seroma, surgical site hematoma, inguinal region pain, recurrence, and deep vein thrombosis between the observation group and the control group (P>0.05).

For patients with inguinal hernia on a single antiplatelet agent (aspirin or clopidogrel), performing Lichtenstein repair under local anesthesia in strictly managed medical centers with established ambulatory admission protocols is safe and feasible. This approach does not significantly increase the risk of perioperative or short-term postoperative complications.

To summarize the clinical experience of laparoscopic surgical treatment for diaphragmatic hernia.

The clinical data of 10 patients with diaphragmatic hernia who underwent laparoscopic surgery at Nanjing Jiangbei Hospital between January 2022 and October 2024 were retrospectively analyzed. The key operative steps were as follows: first, reduction of the hernia contents was performed, and adhesions between the hernia ring and surrounding tissues were carefully dissected to achieve complete exposure of the defect; next, the thoracic cavity was explored, and the hernia ring was closed with non-absorbable sutures; the length of the hernia ring was then measured, and an anti-adhesion mesh was placed to overlap the weakened area by at least 3 cm; finally, the mesh was reinforced using a tacker and sutures. Postoperative recovery was assessed through outpatient visits and telephone follow-up.

All patients underwent preoperative multidisciplinary team discussion. Two patients had a Nutritional Risk Screening 2002 (NRS 2002) score ≥3 and received nutritional support. Intraoperatively, nine patients were diagnosed with left-sided diaphragmatic hernia and one with right-sided hernia. The most common hernia contents were the stomach (7 cases), colon (6 cases), and greater omentum (5 cases). The mean diaphragmatic defect area was (59.0±28.4) cm², the mean operative time was (124.5±35.9) minutes, and the median intraoperative blood loss was 25 (20, 50) ml. The hernia sac was preserved in all cases. Postoperatively, four patients required respiratory support in the intensive care unit. The most common complications were pleural effusion and pulmonary infection. All patients were discharged uneventfully. The median length of hospital stay was 11.5 (9.3, 19.0) days, and the median follow-up duration was 16.5 (13.5, 19.5) months. During follow-up, no recurrence of diaphragmatic hernia or other related complications was observed.

Laparoscopic diaphragmatic hernia repair has the advantages of thorough exploration, minimal collateral injury, and safety and reliability. Preoperative nutritional support, multidisciplinary discussion, intraoperative preservation of the hernia sac, reinforcement of the mesh, and postoperative respiratory support may contribute to improved patient recovery.

To explore the prevention and control effect of oxycodone on emergence agitation in patients undergoing laparoscopic hernia repair by optimizing analgesia and stress regulation.

This was a retrospective controlled study. A retrospective analysis was conducted on the medical records of 284 patients with inguinal hernia who underwent laparoscopic hernia repair surgery at Chuiyangliu Hospital affiliated with Tsinghua University from January 2023 to October 2025, the patients were divided into an experimental group and a control group, with 142 patients in each group, according to different anesthesia methods. The control group was given conventional anesthesia, while the experimental group was combined with oxycodone anesthesia on the basis of the control group. The perioperative conditions, Visual Analogue Scale (VAS) scores, serum cortisol, norepinephrine (NE), epinephrine levels, recovery conditions, and the incidence of adverse reactions were compared.

The extubation time and recovery time in the experimental group were both shorter than those in the control group (P<0.05, both effect sizes were 0.35). The VAS scores in the experimental group at 4, 8, 12 and 24 hours after the operation were lower than those in control group (P<0.05, effect size range: 0.24 to 0.41). Immediately after the operation, the levels of serum cortisol, NE, and epinephrine in the experimental group were lower (P<0.05, effect size range: 0.32 to 0.40). The Richmond Restlessness and Sedation Scale (RASS) scores in the experimental group at the moment of extubation and 10 minutes and 30 minutes after extubation were all lower than those in the control group, and the incidence of emergence agitation was lower (P<0.05, effect size range: 0.25 to 0.38). Comparison of the incidence of excessive sedation and adverse reactions between the two groups, with no statistically significant difference (P>0.05, both effect sizes were 0.024).

Oxycodone can enhance the analgesic effect after laparoscopic hernia repair, alleviate stress responses, and reduce the incidence of emergence agitation.

To evaluate the effectiveness and safety of local infiltration anesthesia based on nerve distribution for Lichtenstein procedure.

From January 2020 to December 2022, 107 patients who underwent with unilateral inguinal hernia local infiltration anesthesia Lichtenstein surgery in Department of Gastrointestinal Surgery, the Third People's Hospital of Shenzhen were retrospectively selected. Pain score during and after operation, anesthesia satisfaction, dosage of anesthetic drugs, and incidence rate of toxicity of anesthetic drugs were analyzed.

All patients completed the operation under local anesthesia, and no toxicity of anesthetic drugs occurred. The pain Visual Analogue Scale scores during the operation and on the first day after the operation were (1.86±0.47) points and (1.85±0.48) points, respectively. The average dosage of anesthetic drugs was (27.63±5.98) ml, and the satisfaction of anesthesia was 100%.

Local infiltration anesthesia based on nerve distribution for Lichtenstein procedure is effective, safe and feasible with a small dosage of anesthetic drugs and a low probability of toxicity.

To evaluate the safety and effectiveness of open Lichtenstein tension-free hernia repair under local infiltration combined with nerve block anesthesia in patients with peritoneal dialysis (PD)-related inguinal hernia.

Clinical data of 63 patients with peritoneal dialysis-related inguinal hernia who were treated between February 2015 and February 2025 at Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, and its affiliated centers (Yanqing Hospital of Beijing Chinese Medicine Hospital and Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital) were retrospectively analyzed. All patients underwent open Lichtenstein tension-free hernia repair under local infiltration combined with nerve block anesthesia. Demographic characteristics, hernia type, operative indicators, perioperative complications, and follow-up outcomes were collected. Using descriptive statistical methods, continuous variables are presented as median (Q₁,Q₃), and categorical variables as number (%).

All 63 patients successfully completed the procedure. The median age was 64 (60, 67) years, and the median duration of peritoneal dialysis was 33 (17, 50) months. Indirect inguinal hernia was the predominant type (87.3%), and bilateral hernias accounted for 27.0%. The median operative time was 50 (45, 58) minutes, and the median postoperative hospital stay was 1.5 (1.0, 2.0) days. The median Visual Analog Scale (VAS) pain score at 24 hours postoperatively was 2 (1, 2) points. Perioperative dialysis was managed according to a standardized protocol, including temporary cessation of peritoneal dialysis with transition to hemodialysis preoperatively and stepwise resumption of peritoneal dialysis postoperatively after a median of 7 (7,7) days. No dialysate leakage or peritonitis occurred during the perioperative period. Minor complications within 30 days occurred in 6.3% of patients and resolved with conservative management. In the 60 patients who completed the 1-year postoperative follow-up, no hernia recurrence was observed.

For patients with peritoneal dialysis-related inguinal hernia, open Lichtenstein tension-free repair under local anesthesia combined with standardized perioperative dialysis management appears to be safe and feasible. It can achieve low postoperative pain, short hospital stay, and favorable short- to mid-term outcomes. Prospective controlled studies are warranted to further validate these findings and optimize dialysis management strategies.

To investigate the effects of ultrasound-guided anterior and posterior quadratus lumborum block (QLB) for analgesia after unilateral inguinal hernia repair surgery.

Sixty patients who underwent elective unilateral open inguinal hernia repair in Wuhu First People's Hospital from February 2020 to February 2022 were selected and randomly divided into anterior QLB group (group A) and posterior QLB group (group B), with 30 patients in each group. QLB was performed before general anesthesia induction. Sufentanil PICA was completed after the operation. Intramuscular injection of dezocine was given for remedial analgesia. Numerical rating scale (NRS) scores were recorded at 2, 6, 12, 24 h postoperatively at rest and when sitting up from the lying position. The first pressing time of analgesia pump, analgesia pump effective press number, the number of cases requiring remedial analgesia within 24 h, and VRS satisfaction score were recorded. The occurrence of lower limb muscle weakness, nausea and vomiting, drowsiness, hypotension and other adverse reactions and complications such as infection, visceral injury, hematoma, and local anesthetic poisoning were recorded.

The NRS score when sitting up from the lying position of group A was lower than that of group B at 12 and 24 h after surgery (P<0.05). The proportion of high satisfaction in group A was significantly higher than that of group B (P<0.05) at 48 h after operation. The first pressing time of the analgesic pump, the number of effective pressing of the analgesic pump, the number of 24 h remedial analgesia cases, and the incidence of nausea and vomiting in group A were significantly lower than those in group B (P<0.05). There was no statistically significant difference in the incidence rates of hypotension, muscle weakness, and drowsiness between the two groups (P>0.05). There were no complications such as infection, visceral injury, hematoma, and local anesthetic poisoning in the two groups.

For patients undergoing unilateral inguinal hernia repair, the analgesic effect of anterior QLB under ultrasound guidance is better than that of posterior approach.

To investigate the effects of remimazzolam besylate combined with sufentanil on postoperative cognitive function, recovery quality, and inflammatory mediators in elderly patients undergoing laparoscopic inguinal hernia repair.

This study adopted a prospective, randomized, controlled, single-blind clinical trial design. A total of 200 elderly patients who underwent laparoscopic hernia repair at the Fifth People's Hospital of Yibin between January 2022 and September 2025 were enrolled. Patients were randomly assigned into an observation group and a control group using a simple random sampling method, with 100 cases in each group. The control group received propofol combined with sufentanil anesthesia, while the observation group received remimazolam besylate combined with sufentanil anesthesia. Cognitive function was assessed preoperatively and at 24 and 48 hours postoperatively. The quality of recovery (including awakening time and extubation time), levels of inflammatory mediators [tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-1β, and S100β protein] before surgery and at 24 hours postoperatively, and the incidence of adverse reactions before discharge were compared between the two groups.

At 24 and 48 hours postoperatively, the Montreal Cognitive Assessment (MoCA) scores and Mini-Mental State Examination (MMSE) scores in the observation group were higher than those in the control group (P<0.05). The awakening time and extubation time in the observation group were shorter than those in the control group (P<0.05). At 24 hours postoperatively, the serum levels of TNF-α, IL-6, IL-1β, and S100β protein in the observation group were lower than those in the control group (P<0.05; partial η² values for between-group effects were 0.05, 0.03, 0.05, and 0.04, respectively). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (P=0.469; effect size Cramer's V=0.05).

Remimazolam besylate combined with sufentanil can improve postoperative cognitive function, enhance the quality of recovery, and reduce inflammatory mediators in elderly patients undergoing laparoscopic hernia repair.

To evaluate the safety and short-term efficacy of robot-assisted surgery in the treatment of complex abdominal wall hernia.

This was a retrospective cohort study. A retrospective analysis was performed on the clinical data of 41 patients who underwent complex abdominal wall hernia repair at Tianjin Nankai Hospital between February 2023 and February 2025. According to different surgical approaches, patients were divided into the LH group (laparoscopic tension-free abdominal wall hernia repair, n=23) and the RH group (robot-assisted tension-free abdominal wall hernia repair, n=18). The perioperative conditions (abdominal adhesion score, intraoperative blood loss, operation time, and diameter of abdominal wall defect), Visual Analogue Scale (VAS) pain scores at postoperative 3 days, 1 week, 1 month, and 3 months, as well as the incidence rate of postoperative complications including hernia recurrence, intestinal obstruction, intestinal fistula, wound infection, mesh infection, hematoma, and seroma were compared between the two groups. According to different hernia types, patients were divided into 5 subgroups: group A [giant abdominal wall hernia (maximum defect>10 cm)], group B (abdominal wall hernia with severe intra-abdominal adhesions), group C (recurrent/multiple hernias), group D (marginal hernia), and group E (incarcerated/strangulated hernia). Statistical analysis was further performed for subgroups with a case number of≥6.

There was no statistically significant difference in general data between the two groups (P>0.05). No significant differences were found in the perioperative conditions (abdominal adhesion score, intraoperative blood loss, operation time, abdominal wall defect diameter) between the two groups (P>0.05). The VAS pain scores at 1 week and 1 month postoperatively in the RH group, as well as at all observed time points in subgroup D, were lower than those in the LH group, with statistically significant differences (P<0.05). The LH group was followed up for 6-24 months, and the RH group for 3-12 months. All patients completed the follow-up. During the follow-up period, the LH group had 2 cases of seroma, 1 case of hernia recurrence at 1 year postoperatively, and 1 case of chronic pain. The RH group had 1 case of seroma.The total complication rates were 17.4% (4/23) and 6% (1/18), respectively, with no statistically significant difference between the two groups (P=0.258).

Robotic- assisted and laparoscopic surgery have comparable safety in the treatment of complex abdominal wall hernia. Compared with conventional laparoscopic surgery, robotic-assisted technology offers advantages such as improved surgical precision and less postoperative pain in complex abdominal wall hernia repair, especially in pain control for marginal incisional hernias.

To investigate the conversion to open surgery and related risk factors in patients with incarcerated inguinal hernia undergoing laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) hernioplasty.

A total of 101 patients with incarcerated inguinal hernia who were hospitalized in the Department of Hernia and Abdominal Wall Surgery, Huadu District People's Hospital of Guangzhou from January 1, 2020 to December 30, 2024 were selected. Among them, 79 patients underwent complete TAPP surgery and 22 patients were in the laparoscopic conversion to open surgery group. Clinical data of the two groups were analyzed to explore the status of conversion to open surgery in TAPP for incarcerated inguinal hernia. Univariate and multivariate analyses were used to identify relevant risk factors for conversion to open surgery, and a predictive model was established accordingly.

The conversion to open surgery in TAPP for incarcerated inguinal hernia was correlated with gender, smoking history, onset time of hernia, hernia ring diameter, peritoneal effusion, C-reactive protein (CRP), intestinal obstruction, and hernia size. Binary multivariate logistic regression analysis revealed that CRP (OR=1.43, 95% CI 1.18-1.72) and peritoneal effusion (OR=1.24, 95% CI 1.01-3.18) were independent risk factors for conversion to open surgery in patients with incarcerated inguinal hernia undergoing TAPP. The predictive model established based on these risk factors showed good consistency with actual observation results after 500 model validations, indicating statistical significance.

Conversion to open surgery in incarcerated inguinal hernia is correlated with gender, smoking history, onset time of hernia, hernia ring diameter, peritoneal effusion, CRP, intestinal obstruction, and hernia size. Early surgical treatment is recommended for incarcerated inguinal hernia. When a patient's CRP level exceeds 11.85 mg/L, or when peritoneal effusion is present, preparations for open surgery should be made in advance.

To investigate the short-term efficacy and safety of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) and Lichtenstein's tension-free hernia repair (Lichtenstein) in the treatment of bilateral primary inguinal hernias in adult males.

A total of 108 adult male patients with bilateral primary inguinal hernia in The Second Hospital of Hebei Medical University from May 2021 to March 2024 were selected as the study subjects. According to the treatment regimens, patients were grouped and selected using a 1:1 matching method. The 54 patients who were treated with the Lichtenstein procedure were included in the Lichtenstein group, and the 54 patients who were treated with the TAPP procedure were included in the TAPP group. The perioperative indicators and postoperative complications were compared between the two groups, as well as the stress hormone levels [cortisol (Cor), norepinephrine (NE), acetylcholine (ACH)] before surgery and 1 day before discharge, the serum testosterone and sperm quality before and 3 months after surgery, the scores of International Index of Erectile Function -5 (IIEF-5), the Chinese Premature Ejaculation Questionnaire (CIPE), and the inguinal pain questionnaire (IPQ) before and 3 months after surgery. The recurrence rate at 1 year after surgery was analyzed.

The postoperative 24-hour numerical rating scale (NRS) score in TAPP group was (3.27±0.52) points, which was lower than that in Lichtenstein group (6.69±1.27) points, the postoperative ambulation time, exhaust time and hospitalization time were (15.37±2.69) h, (19.64±3.26) h and (3.69±0.87) d, respectively, which were shorter than those in Lichtenstein group (24.11±5.02) h, (26.87±5.51) h and (5.34±1.12) d, the cost of treatment (1.82±0.25) ten thousand yuan was higher than that of Lichtenstein group (1.36±0.19) ten thousand yuan (P<0.05). The levels of serum NE, ACH and Cor in TAPP group 1 day before discharge were (4.52±0.78) μg/L, (25.44±2.17) pg/ml and (598.41±37.24) mmol/L, respectively, which were lower than those in Lichtenstein group [(5.11±0.82) μg/L, (28.63±2.27) pg/ml, (624.11±40.11) mmol/L], and the difference was not statistically significant (P>0.05). The operation time, postoperative complications and recurrence rate within 1 year after operation in TAPP group were (91.27±18.73) min, 9.26% and 1.85%, respectively, which were not significantly different from those in Lichtenstein group (91.27±18.73) min, 12.96% and 3.70% (P>0.05). There were no significant differences in serum testosterone, sperm concentration, total sperm motility, sperm malformation rate, IIEF-5 score, CIPE score, and IPQ score before surgery and three months after surgery, as well as between the two groups (P>0.05).

Both the Lichtenstein procedure and the TAPP procedure have demonstrated good efficacy in treating bilateral inguinal hernias in adult males, and neither procedure has any impact on the patient's reproductive system. The TAPP procedure has advantages in reducing stress response, alleviating pain, and facilitating rapid postoperative recovery. However, its hospitalization costs are relatively high. Clinically, appropriate surgical procedures can be selected based on the patient's condition.

To analyze the clinical characteristics and surgical safety of diaphragmatic repair in patients undergoing hepatosplenic surgery.

A retrospective cohort study was conducted. A total of 36 patients who underwent diaphragmatic repair during hepatosplenic procedures between January 2019 and June 2025 at Suining Central Hospital and Suining Hospital of Traditional Chinese Medicine. Patients were categorized by cause of injury into disease invasion group (n=17), iatrogenic injury group (n=8), and trauma group (n=11). Patients were categorized by repair method into suture group (n=26) and mesh group (n=10). The clinical characteristics and surgical outcomes of each group were compared.

The trauma group had a higher proportion of emergency surgery (P<0.001) and significantly greater total blood loss [(1100.0±297.5) ml] compared to the disease invasion group[(174.3±77.5) ml] and the iatrogenic injury group [(160.5±64.3) ml] (P<0.001). Mesh repair was used for larger defects [defect width: (2.5±0.69) cm vs. (0.5±0.25) cm; defect area: (11.1±3.33) cm² vs. (2.4±1.36) cm², both P<0.001]. It also required a longer diaphragmatic procedure time [(43.4±6.9) min vs. (22.5±7.1) min, P<0.001], but there was no statistically significant difference in the total operation time (P=0.595). The incidence rates of diaphragm surgery-related complications were compared among the traumatic group, disease invasion group, and iatrogenic injury group [36.4% (4/11), 29.4% (5/17), and 37.5% (3/8)], with no statistically significant difference (P>0.05).The overall complication rate was 33.3% (12/36), all of which were classified as Clavien-Dindo grade I-Ⅲ. Binary logistic regression analysis showed that trauma (OR=1.500, 95% CI 0.330-6.822, P=0.600), surgical approach (laparoscopic vs. open, OR=0.467, 95% CI 0.100-2.173, P=0.331), surgical timing (emergency vs. elective, OR=1.000, 95% CI 0.230-4.349, P=1.000), repair method (mesh vs. suture, OR=0.368, 95% CI 0.081-1.672, P=0.196), and the placement of thoracic drainage (OR=1.667, 95% CI 0.282-9.856, P=0.573) were not independent risk factors for complications.

Diaphragmatic repair in hepatosplenic surgery is generally safe and the complications are controllable. Mesh repair is indicated for larger defects and extends operative time. Although trauma cases are associated with greater blood loss, they do not independently increase the risk of complications. Further studies are needed to identify modifiable risk factors.

To evaluate the clinical performance of two liver retraction techniques during laparoscopic hiatal hernia repair.

A total of 36 patients who underwent laparoscopic surgery for hiatal hernia in the Department of General Surgery, Qinghe County Central Hospital, Hebei Province, between December 2022 and December 2024 were retrospectively reviewed. Sixteen patients received liver retraction using an atraumatic grasper inserted via a subxiphoid port (grasper group), and 20 patients received liver retraction using a dedicated liver retractor inserted via a subxiphoid port (retractor group). A retrospective comparison was conducted to determine the effectiveness and safety of the two liver retraction methods in laparoscopic hiatal hernia repair.

All 36 patients successfully completed the procedure. There were no significant between-group differences in sex, age, or body mass index (P>0.05). The liver retractor setup time was significantly shorter in the grasper group than in the retractor group (P<0.05). Between-group comparisons showed no significant differences in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), or total bilirubin levels preoperatively, on postoperative day 1, or before discharge (all P>0.05). Within-group comparisons indicated that ALT and AST levels on postoperative day 1 were significantly higher than preoperative levels in both groups (P<0.05), whereas total bilirubin on postoperative day 1 did not differ significantly from preoperative values (P>0.05). Before discharge, ALT and AST levels were significantly lower than those on postoperative day 1 (P<0.05), while total bilirubin before discharge did not differ significantly from postoperative day 1 (P>0.05). No significant differences were observed between preoperative values and those before discharge for ALT, AST, or total bilirubin (all P>0.05). There were no significant between- group differences in overall operative time or length of hospital stay (P>0.05). All patients were followed for at least 6 months after discharge, during which no recurrence, bleeding, or obstruction was observed in either group.

Compared with a dedicated liver retractor, liver retraction using an atraumatic grasper requires a shorter setup time, without a significant impact on total operative time. Both techniques appear safe and are not associated with severe or long-term liver injury.

To evaluate the clinical outcomes of biological meshes in inguinal hernia repair.

Male patients with unilateral inguinal hernia who underwent Lichtenstein repair at the Second Hospital of Jilin University between January 2019 and January 2022 were retrospectively collected. Patients were assigned to a biological mesh group or a synthetic mesh group according to the mesh used. Hospitalization costs, operative time, anesthesia modality, postoperative length of stay, time to return to normal daily activities, and postoperative complications were compared between the two groups.

A total of 188 patients were included, with 86 in the biological mesh group and 102 in the synthetic mesh group. Significant between-group differences were observed in hospitalization costs and operative time (both P<0.05). No significant differences were found in anesthesia modality, postoperative length of stay, or time to return to normal daily activities (all P>0.05). The biological mesh group had significantly lower rates of foreign-body sensation, chronic postoperative pain, and overall postoperative complications (all P<0.05). However, there were no significant differences in postoperative fever, surgical site infection, mesh infection, seroma, postoperative urinary retention, hernia recurrence, or early postoperative pain (all P>0.05).

In Lichtenstein inguinal hernia repair, compared with synthetic mesh, biological mesh is associated with higher hospitalization costs and longer operative time, but it significantly reduces postoperative foreign-body sensation and chronic pain and decreases the overall incidence of postoperative complications.

Diastasis recti abdominis (DRA) is a relatively common abdominal wall disorder, characterized by the thinning and widening of the linea alba, along with increased separation between the two rectus abdominis muscles. The use of mesh in the surgical treatment of DRA remains controversial. As the concept of abdominal core health(ACH) was proposed, surgeons specializing in hernias and abdominal wall disorders should reacquaint DRA, including the clinical manifestations, the treatment and the mesh use. Studies have shown the benefits of mesh repair in patients with DRA. However, these assessments were not detailed or comprehensive enough. Currently, there is a great need of standardized instruments for measuring the abdominal core health after mesh repair.

Mesh infection following tension-free repair of abdominal external hernia is one of the most challenging and severe complications in the field of hernia surgery. Although its overall incidence is low, once it occurs—particularly in cases of delayed-onset mesh infection—the management process is extremely complex. It causes significant physical and psychological suffering imposes a substantial economic burden to patients, and places considerable pressure on the healthcare system. Unlike the acute infections that occur early after surgery, delayed-onset mesh infection has distinct clinical and pathological characteristics, with its core pathogenesis closely related to the formation of bacterial biofilms. This article systematically analyzes the risk factors associated with delayed-onset mesh infection following tension-free repair of abdominal external hernia, aiming to provide a reference for effective risk stratification, the development of preventive strategies, and the selection of appropriate treatment plans.

Focusing on the core theme of full-cycle management of abdominal wall hernia, this article systematically reviews the latest clinical progress in the construction of three-level prevention system and perioperative multimodal intervention. Through the integration of multidisciplinary theories and evidence-based evidence in surgery, imaging, materials science, rehabilitation medicine and traditional Chinese medicine, the precise identification and quantitative intervention strategies of high-risk and moderate-risk groups in primary prevention, the innovative application of early screening technology in secondary prevention, and the key path of postoperative recurrence prevention in tertiary prevention were analyzed in depth. At the same time, it focuses on the practical implementation of enhanced recovery after surgery and the value of integrated traditional Chinese and western medicine in perioperative management. The purpose of this paper is to provide theoretical basis and practical reference for the clinical construction of the "prevention, diagnosis, treatment and rehabilitation" integrated management system, and promote the development of the diagnosis and treatment mode of abdominal wall hernia to the direction of precision and individualization.

Inguinal ovarian hernia in adult women is rare, and cases concomitant with adenomyoma of the uterine round ligament are even rarer. Here, we report the diagnostic and therapeutic course of a 49-year-old woman with a right-sided inguinal ovarian hernia complicated by adenomyoma of the round ligament. We further analyzed this case in conjunction with the literature, with a focus on the clinical characteristics, diagnosis, and management of adult inguinal ovarian hernia. Preoperative diagnosis remains challenging, and the condition is prone to misdiagnosis or missed diagnosis. Imaging modalities such as ultrasonography, computed tomography, or magnetic resonance imaging demonstrating an "absent" ipsilateral ovary can facilitate the diagnosis. Surgery is the mainstay of treatment. Intraoperatively, particular attention should be paid to preserving the ovary and reproductive function, and hernia repair should be performed to prevent postoperative recurrence.