Background/Objectives: Ventral hernia repair (VHR) is a common surgical intervention linked to specific surgical site complications. In such occurrences, the related morbidity is often substantial. Although known risk factors have long been recognized, their systematic inclusion in risk stratification systems lacks universal validation. This study evaluates the effectiveness and correspondence of three risk assessment tools—CeDAR, VHWG, and the modified VHWG—in predicting postoperative wound complications in VHR patients. Methods: We analyzed data from 203 patients who underwent VHR for incisional midline or lateral wall hernia across two surgical departments between 2019 and 2023. Each patient was scored using CeDAR, VHWG, and the modified VHWG systems. Outcomes were assessed based on surgical site occurrences (SSOs) such as seroma formation, wound infections, and recurrences. Results: The incidence of SSOs was 8.9%, with two recorded deaths (0.89%). CeDAR scores showed a statistically significant relationship with SSOs but failed to accurately predict complication rates across subgroups. The VHWG grading system effectively predicted higher complication rates for grades III and IV compared to grades I and II, though its modified version did not show significant predictive improvements. Secondary outcomes indicated a higher SSO rate in patients requiring posterior component separation (TAR) and those with larger hernia defects, though the differences were not statistically significant. Major preoperative risk factors, including smoking, diabetes, and obesity, did not show significant correlations with SSO rates in this study. Conclusions: Current risk estimation tools inadequately predict SSOs in VHR. Enhancing prediction accuracy will require incorporating both patient-specific and surgical factors, potentially through advanced algorithms and large-scale studies.
Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis for the general surgeon performing a regular inguinal hernia surgery. This study aims to collect the relevant literature describing the diagnosis and management of ureteroinguinal hernias and update it with a case encountered in our clinic. The following study was reported following the SCARE guidelines. The relevant literature describes less than 150 cases of ureteroinguinal hernias overall, considering the 1.7% prevalence of inguinal hernias in the general population. With only 20% of these hernias being described as extraperitoneal, such an encounter becomes an extremely rare finding. Our clinical experience brings a case of a 75-year-old male with frequent urinary tract infections and a large irreducible inguinoscrotal hernia of about 20/12 cm located at the right scrotum. The patient underwent an open inguinal hernia repair technique under general anesthesia, incidentally finding an extraperitoneal ureteral herniation. Segmental ureterectomy was performed with uneventful recovery. Intraoperatively, finding an incidental ureteroinguinal hernia raises concerns about probable urinary tract complications during regular hernia repair surgery and whether the diagnosis is likely to happen prior to surgical intervention. Although imaging is rarely indicated in inguinal hernias, the case reports show that a pelvic CT scan with urography in symptomatic patients with urinary symptoms will provide accurate confirmation of the diagnosis. The relevant literature is limited due to the rarity of respective cases, thus making standardized management of such cases unlikely.
Background: The benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) in ovarian cancer with peritoneal metastasis remains debated outside selected indications. We performed a systematic review and meta-analysis to quantify survival, perioperative morbidity, and completeness of cytoreduction using study-level data. Methods: PubMed/MEDLINE, Embase, and Web of Science were searched. Eligible English-language studies included ovarian cancer patients undergoing CRS plus HIPEC and reported at least one of the following: overall survival (OS), progression-free survival (PFS), Grade III–IV complications, or CC-0 rate. Random-effects meta-analyses were conducted using inverse-variance pooling. For HR outcomes, DerSimonian–Laird τ2 with Hartung–Knapp confidence intervals was applied. Proportions were pooled using logit transformation (PLOGIT) with random-effects models. Results: Twelve studies (n = 567) were included. Only two studies provided extractable HRs for OS and PFS (n = 217). CRS plus HIPEC was associated with improved OS (HR 0.68, 95% CI 0.52–0.90, p = 0.0023; I2 = 0%; prediction interval 0.14–3.34) and improved PFS (HR 0.70, 95% CI 0.31–1.57, p = 0.0007; I2 = 0%; prediction interval 0.18–2.66). Across 12 studies (n = 563), the pooled Grade III–IV complication rate was 0.18 (95% CI 0.14–0.22; I2 = 16.3%; prediction interval 0.12–0.26). In 10 studies (n = 385), the pooled CC-0 rate was 0.87 (95% CI 0.79–0.92; I2 = 46.7%; prediction interval 0.66–0.96). Conclusions: CRS plus HIPEC shows a favorable signal for OS and PFS in the limited HR-eligible evidence and appears feasible, with a pooled severe complication rate of ~18% and high CC-0 rates. Current data support HIPEC primarily as a targeted intensification strategy in carefully selected patients, while broader adoption requires additional randomized, context-specific evidence.