Predicting fascial non-closure in ventral hernia repair with transversus abdominis release: risk factors, clinical outcomes, and implications for surgical planning.

Background: Posterior components separation with transversus abdominis release (TAR) reduces tension on the anterior and posterior fascial elements in complex ventral hernia repairs, but its use does not ensure complete fascial closure. This study evaluates the relationship between hernia size and anterior fascial closure success rates following TAR and identifies predictive factors for non-closure.

Methods: We retrospectively analyzed 1,677 patients who underwent open ventral hernia repair with TAR and synthetic mesh placement at a single institution from 2014 to 2023.

Subjective workload in operating room team members during robotic hernia procedures.

While robotic surgery has been dominated by a single platform in the United States for over 25 years, the introduction of new robotic systems may have an impact on subjective workload. Therefore, we aimed to establish baseline workload measurements for operating room team members using the DaVinci surgical robot during robotic hernia procedures, providing reference points for evaluating team adaptation as new robotic platforms are introduced. Within the operating room, subjective workload refers to the physical, cognitive, and temporal demands experienced during surgical procedures.

Comparing Ventral Hernia Repair Outcomes in Patients With and Without Liver Insufficiency.

Background: In patients with liver insufficiency, there is a high prevalence of ventral hernias. However, the decision to proceed with elective surgery must be balanced with the increased perioperative risk in patients with liver disease. Our study aimed to compare ventral hernia repair outcomes in patients with and without liver insufficiency.

Mesh-related Outcomes of Biologic versus Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias: A Five to Ten Year Analysis of a Randomized Controlled Trial.

Objective: To determine the five- to ten-year safety and durability outcomes of biologic versus synthetic mesh in contaminated ventral hernia repair.

Summary Of Background Data: Recent randomized controlled trials have demonstrated the safety and efficacy of synthetic mesh in clean-contaminated and contaminated ventral hernia repairs, but follow-up has typically been limited to two years. Concerns persist regarding long-term outcomes of synthetic mesh beyond this initial period.

Characterizing a clinically significant radiographic parastomal hernia recurrence: post hoc analysis of a randomized controlled trial.

Introduction: Parastomal hernia recurrence is common but poorly defined. We aimed to correlate radiographic recurrence and reoperation for parastomal hernia recurrence with patient-reported outcomes (PROs) to determine the clinical significance of radiographic recurrence and identify potential screening tools.

Methods: Patient data in the one- and two-year follow-up windows of a registry-embedded randomized controlled trial comparing open retromuscular Sugarbaker and keyhole mesh parastomal hernia repairs (2019-2022) were analyzed.

Impact of Second Opinions on Time to Treatment of Breast Cancer.

Background: The Commission on Cancer (CoC) advocates that upfront breast surgery is performed within 60 days of diagnosis of stage I-III breast cancer, but it is unknown whether patients seeking a second opinion at an outside institution experience increased delays in time to first treatment (TTT). This study compares TTT between externally diagnosed patients (EDP) and internally diagnosed patients (IDP) with breast cancer.

Methods: This retrospective cohort study included patients with stage 0-III breast cancer treated at a single institution between January and July 2024.

Venous thromboembolism after ventral hernia repair with transversus abdominis release.

Introduction: Venous thromboembolism (VTE) events, such as pulmonary embolism (PE) and deep venous thrombosis (DVT), are a significant source of morbidity and mortality after major abdominal wall reconstruction. We aim to describe the incidence of VTE events in patients undergoing ventral hernia repair (VHR) with transversus abdominis release (TAR) at our institution.

Methods: The Abdominal Core Health Quality Collaborative registry was queried for patients, 18 years and older, who underwent VHR with TAR at our institution between August 2014 and December 2023.

Comparing robotic to open retromuscular ventral hernia repair: a multi-center propensity-matched analysis.

Introduction: Robotic retromuscular ventral hernia repair (r-RVHR) may benefit patients by converting an open surgery (o-RVHR) to a minimally invasive approach. Current comparative trials are limited by small patient cohorts and exploratory outcomes. This study compares short- and long-term outcomes of robotic versus open retromuscular ventral hernia repairs using a nationwide registry.

Does prior mesh infection matter? Clinical outcomes of patients undergoing complex abdominal wall reconstruction after infected mesh explantation.

Background: While mesh infection after ventral hernia repair often requires explantation and subsequent repair, the association between prior mesh infection with outcomes following complex abdominal wall reconstruction remains poorly understood.

Methods: A two-stage propensity score-matched analysis was performed using the Abdominal Core Health Quality Collaborative database. Patients undergoing clean, elective, open ventral hernia repair with prior mesh infections were compared with those with no prior wound morbidity and non-mesh-related surgical site infections (SSIs).

Successful Abdominal Wall Reconstruction Following Liposuction Catastrophe: A Case Report and Literature Review.

Background: Devastating abdominal injuries may result from liposuction, which can lead to necrotizing fasciitis and loss of abdominal domain. This may necessitate reconstructing the abdominal wall to improve the patient's quality of life.

Objectives: The study aims to raise awareness among the readers of this catastrophic complication.

Integrating Sustainability Into Graduate Medical Education for Surgical Trainees.

Climate change represents an escalating threat to global health, with unique implications for surgical care and training. Given that the healthcare sector significantly contributes to greenhouse gas emissions, surgical trainees must be equipped to practice sustainably. We propose integrating climate-related content into surgical training through resident education, research initiatives, and faculty leadership.

Robotic versus open ventral hernia repair (ROVHR): a randomized controlled trial protocol.

Background: Robotic retromuscular hernia repair has proven to be feasible and safe but lacks randomized data to demonstrate significant clinical benefit. The majority of current comparative studies published have been case series, retrospective studies, systematic reviews, or large registry data, all of which have significant limitations and bias (Bittner et al. in Surg Endosc 32:727-734.

Lateral abdominal wall hernias after coughing: a single center experience.

Purpose: Forceful coughing is assumed to be an uncommon etiology for lateral abdominal wall hernias. The literature regarding this topic is very limited and there is a lack of consensus in management, both operative and non-operative. We aim to report our center's experience in repair of lateral abdominal wall hernias secondary to vigorous coughing.

Characterizing patterns of opioid prescribing after outpatient ventral hernia repair with mesh.

Purpose: Despite efforts to minimize opioid prescribing, outpatient ventral hernia repair (VHR) with mesh remains notoriously painful, often requiring postoperative opioid analgesia. Here, we aim to characterize patterns of opioid prescribing for the heterogenous group of patients and procedures that comprise mesh-based, outpatient VHR.

Methods: The Abdominal Core Health Quality Collaborative registry was queried for patients undergoing VHR with mesh who were discharged the same or next day between January 2019 to October 2023.

Patient reported outcomes and decision regret scores in redo-paraesophageal hernia repair.

Introduction: Recurrent paraesophageal hernia (PEH) repair presents significant technical challenges, with limited data weighing the benefit to the operative risk. This study aims to describe our experience with recurrent PEH repair, including long-term surgical and patient reported outcomes (PROs).

Methods: We conducted a retrospective review of recurrent PEH repairs from June 2018-March 2023 using our institutional database.

The role of chemotherapy in the management of pancreatic acinar cell carcinoma.

Introduction: Pancreatic acinar cell carcinoma (pACC) is a rare malignancy with unique clinical and molecular features. The role of chemotherapy in pACC management is not well established.

Methods: The National Cancer Database (NCDB) for pACC was used.

Comparing oncologic and surgical outcomes of robotic and laparoscopic distal pancreatectomy: a propensity-matched analysis.

Background: The frequency of minimally invasive distal pancreatectomy is gradually exceeding that of the open approach. Our study aims to compare short-term outcomes of robotic (RDP) and laparoscopic (LDP) distal pancreatectomies for pancreatic ductal adenocarcinoma (PDAC) using a national database.

Methods: The National Cancer Database was utilized to identify patients with PDAC who underwent distal pancreatectomy from 2010-2020.

Does reusable mean green? Comparison of the environmental impact of reusable operating room bed covers and lift sheets versus single-use.

Introduction: As hospitals strive to reduce their environmental footprint, there is an ongoing debate over the environmental implications of reusable versus disposable linens in operating rooms (ORs). This research aimed to compare the environmental impact of reusable versus single-use OR bed covers and lift sheets using life cycle assessment (LCA) methodology.

Methods: LCA is an established tool with rigorous methodology that uses science-based processes to measure environmental impact.

The Role of Neoadjuvant Immunotherapy in the Management of Merkel Cell Carcinoma with Clinically Detected Regional Lymph Node Metastasis.

Background: Immunotherapy is emerging as a promising option for certain locally advanced and metastatic cutaneous malignancies. However, the role of neoadjuvant immunotherapy (NIO) in Merkel cell carcinoma (MCC) with clinically detected regional lymph node metastasis (CDRLNM) has not been fully elucidated.

Methods: For this study, MCC patients with CDRLNM who underwent surgical excision were selected from the National Cancer Database (NCDB).

Training Future Surgeon Leaders in Environmental Stewardship: A Review of a Decade of the Health Care Sustainability Fellowship.

Objective: Since the inception of Ken Lee Memorial Fellowship (KLMF) in 2013, our institution has achieved 10 years of trainee led sustainability projects. The ability of health care organizations to drive sustainability depends on organizational and human capacity. This qualitative study presents the first decade of sustainability fellows' projects, the challenges associated with implementing them, and the environmental and cost impact of these initiatives.