The repair of abdominal wall defects has undergone a technical evolution from traditional tissue suturing to modern mesh reinforcement. Its core concept has progressively shifted from mere anatomical reconstruction towards the goal of restoring abdominal wall function. This journey spans early explorations with Onlay and Inlay techniques, to the establishment of the retro-muscular plane as the gold standard, and further to the innovative integration of intraperitoneal onlay mesh (IPOM) and Sublay techniques during the laparoscopic era. IPOM became mainstream due to its advantages of smaller wounds and faster recovery, however, its inherent limitations, including adhesion risks from mesh-viscera contact, chronic inflammatory responses, and fixation-related complications (such as stapling pain and enterocutaneous fistula), has prompted specialists to re-evaluate its indications. With the maturation of laparoscopic retromuscular plane techniques and the rise of robot-assisted Sublay repair, the role of IPOM in abdominal wall defect repair is facing challenges. Its future application may be progressively confined to specific cases. In recent years, the introduction of component separation techniques has expanded the boundaries of anatomical repair, while regenerative medicine-driven biomaterials and functional meshes (e.g., stem cell-loaded scaffolds, immunomodulatory meshes) are driving a paradigm shift towards tissue regeneration. Looking ahead, the integration of surgical robotics, three-dimensional imaging navigation, and artificial intelligence assisted decision-making systems will propel abdominal wall defect repair into a new era of individualized precision therapy. The ultimate goal will no longer be confined to defect closure, but will encompass the comprehensive reconstruction and repair of abdominal wall biome-chanics and the microenvironment. Therefore, the authors systematically review the historical evolution, evidence-based medicine, and future trends of the placement hierarchy of abdominal incisional hernia meshes, aiming to provide guidance for optimizing surgical strategies and impro-ving patient prognosis.

The repair of abdominal wall defects has undergone a technical evolution from traditional tissue suturing to modern mesh reinforcement. Its core concept has progressively shifted from mere anatomical reconstruction towards the goal of restoring abdominal wall function. This journey spans early explorations with Onlay and Inlay techniques, to the establishment of the retro-muscular plane as the gold standard, and further to the innovative integration of intraperitoneal onlay mesh (IPOM) and Sublay techniques during the laparoscopic era. IPOM became mainstream due to its advantages of smaller wounds and faster recovery, however, its inherent limitations, including adhesion risks from mesh-viscera contact, chronic inflammatory responses, and fixation-related complications (such as stapling pain and enterocutaneous fistula), has prompted specialists to re-evaluate its indications. With the maturation of laparoscopic retromuscular plane techniques and the rise of robot-assisted Sublay repair, the role of IPOM in abdominal wall defect repair is facing challenges. Its future application may be progressively confined to specific cases. In recent years, the introduction of component separation techniques has expanded the boundaries of anatomical repair, while regenerative medicine-driven biomaterials and functional meshes (e.g., stem cell-loaded scaffolds, immunomodulatory meshes) are driving a paradigm shift towards tissue regeneration. Looking ahead, the integration of surgical robotics, three-dimensional imaging navigation, and artificial intelligence assisted decision-making systems will propel abdominal wall defect repair into a new era of individualized precision therapy. The ultimate goal will no longer be confined to defect closure, but will encompass the comprehensive reconstruction and repair of abdominal wall biome-chanics and the microenvironment. Therefore, the authors systematically review the historical evolution, evidence-based medicine, and future trends of the placement hierarchy of abdominal incisional hernia meshes, aiming to provide guidance for optimizing surgical strategies and impro-ving patient prognosis.

Objective:To explore the efficacy and surgical seletion or timing for elderly patients(≥85 years) with inguinal hernia.Methods:A retrospective analysis was conducted on clinical data of 323 patients aged ≥ 85 years who underwent surgical treatment for inguinal hernia admitted to the Department of General Surgery of East China Hospital Affiliated to Fudan University from Jan 2020 to Dec 2024.There were 308 males (95.36%) and 15 females (4.64%), with an average age of (87.83 ± 1.91) years. The ASA classification included 15 cases of grade Ⅰ, 209 cases of grade Ⅱ, 97 cases of grade Ⅲ, and 2 cases of grade Ⅳ.Results:Among the 323 patients, there were 20 bilateral hernia cases and 303 unilateral cases. Ninety-seven cases were of scrotal hernia. Surgical methods included 11 TAPP cases, 10 TEP cases, 297 Lichtenstein cases, 3 open suture repair and 2 laparoscopic suture repair. Four cases underwent intestinal resection and in two cases enterostomy was performed. The median follow-up after surgery was 3 months. Hernia recurrence was found in 2 cases, seroma in 14 cases, chronic pain in 2 cases, SSI in 11 cases, intestinal obstruction in 1 case, urinary retention in 3 cases, pulmonary infection in 9 cases, urinary tract infection in 2 cases, cardiovascular and cerebrovascular accidents in 2 cases. The incidence of postoperative complications in the emergency group was significantly higher than that in the elective group. Three deaths occurred within 30 days after surgery, all of which were in the emergency group.Conclusions:Selective inguinal hernia repair is safe and effective for over 85 year old patients with inguinal hernia. The incidence of emergency surgical complications and mortality is significantly increased. Lichtenstein surgery under local anesthesia or regional block anesthesia is the preferred method.

Modern abdominal wall hernia repair has evolved into a systematic engineering project aimed at "functional abdominal wall reconstruction", the success of which largely depends on the deep integration of autologous tissue reconstruction and mesh reinforcement. As the foundation of repair, autologous tissue reconstruction involves meticulous anatomical restoration, tension-control techniques (e.g., component separation technique, transversus abdominis release), and neurovascular protection to restore the integrity of the abdominal wall's layered structures, thereby creating optimal conditions for mesh reinforcement. The selection of mesh materials should follow individualized principles: large-pore lightweight polypropylene mesh is preferred in clean surgeries to achieve a balance between mechanical support and biocompatibility; in contaminated or infected environments, biological meshes, owing to their inherent anti-infection properties and regenerative potential, become the optimal choice for such patients; and for massive defects, a combination of tissue separation techniques and composite mesh strategies is required to balance mechanical demands and biological infection risks. A well-designed repair plan should comprehensively consider patient factors (comorbidities, age), characteristics (size of defect, contamination level, abdominal wall condition), and surgical approach (mesh placement layer), achieving synergistic restoration of anatomical structure, mechanical force distribution, and physiological function, ultimately improving long-term patient outcomes.

Objective:To investigate the long-term efficacy, safety and prognostic factors of intraoperative radiotherapy (IORT) for narrow-margin (resection margin < 1 cm) hepatectomy in patients with hepatocellular carcinoma (HCC) during radical surgery.Methods:A retrospective cohort study was conducted. The data of primary HCC patients undergoing radical surgery and narrow-margin hepatectomy IORT in the Cancer Hospital of the Chinese Academy of Medical Sciences from November 2009 to February 2019 were collected. IORT applied 6 MeV or 9 MeV electron beams and a single irradiation was given to the margin. Kaplan-Meier method was used for the overall survival (OS) and disease-free survival (DFS) analysis; log-rank test was used for survival comparison among subgroups. The recurrence patterns and adverse reactions were recorded. Univariate and multivariate Cox proportional hazards models were used to analyze the factors influencing the OS and DFS.Results:A total of 64 patients were enrolled, with the median age [ M ( Q1, Q3)] of 57 years (49, 63) years. All patients included 55 males (85.9%) and 9 females (14.1%). The median dose of IORT was 15 Gy (range: 12-17 Gy). The median follow-up time was 83.3 (64.4, 91.9) months. The 1-year, 3-year, 5-year, 7-year, 10-year OS rates were 90.4%, 80.6%, 75.5%, 71.4% and 47.6%, respectively; the 1-year, 3-year, 5-year, 7-year,10-year DFS rates were 77.8%, 68.1%, 59.6%, 57.6% and 38.4%, respectively. Univariate Cox regression analysis indicated that preoperative serum alpha-fetoprotein (AFP) > 400 ng/ml was an independent risk factor for poor OS (> 400 ng/ml vs. ≤ 400 ng/ml: HR = 6.57, 95% CI: 2.16-19.96, P < 0.001), while not the independent influencing factor of poor DFS ( HR = 1.71, 95% CI: 0.65-4.52, P = 0.277). The age ≤ 60 years or not, gender, viral hepatitis or not, American Joint Committee on Cancer stage, tumor diameter (> 5 cm or not), tumor number, degree of tumor differentiation, microvascular invasion or not, microsatellite nodules or not, anatomical liver resection or not, and the dose of IORT ≤15 Gy or not were not the independent influencing factors of poor OS and DFS (all P > 0.05). Kaplan-Meier method analysis showed that patients with preoperative serum AFP ≤ 400 ng/ml (48 cases) had better OS compared with those with preoperative serum AFP>400 ng/ml (16 cases) (5-year OS rate: 84.8% vs. 44.9%; 7-year OS rate: 79.9% vs.37.4%), and the difference was statistically significant ( P = 0.002). There was no statistically significant difference in the DFS between the 2 groups ( P = 0.134). During the follow-up, 28 patients (43.8%) relapsed, including 17 cases (26.6%) of early recurrence and 11 cases (17.2%) of late recurrence. No marginal recurrence was observed. There were 22 cases (34.4%) of intrahepatic recurrence alone, 2 cases (3.1%) of extrahepatic recurrence and 4 cases (6.3%) of stimutaneous recurrence inside and outside the liver. The 1-, 3-, 5- and 7-year cumulative recurrence rates inside the liver were 19.0%, 27.2%, 37.4% and 39.3% respectively, and the cumulative recurrence rates outside the liver were 6.4%, 8.0%, 9.6% and 9.6% respectively. There were no adverse reactions above grade 3 in the entire group. There were no surgery-related deaths within 30 d after the operation, and no radiation-induced liver disease occurred. Conclusions:Narrow-margin IORT helps HCC patients receiving hepatectomy to achieve favorable long-term survival and adverse reactions are tolerable. It can be used as a safe and effective adjuvant therapy alternative.

Objective:To explore the efficacy and surgical seletion or timing for elderly patients(≥85 years) with inguinal hernia.Methods:A retrospective analysis was conducted on clinical data of 323 patients aged ≥ 85 years who underwent surgical treatment for inguinal hernia admitted to the Department of General Surgery of East China Hospital Affiliated to Fudan University from Jan 2020 to Dec 2024.There were 308 males (95.36%) and 15 females (4.64%), with an average age of (87.83 ± 1.91) years. The ASA classification included 15 cases of grade Ⅰ, 209 cases of grade Ⅱ, 97 cases of grade Ⅲ, and 2 cases of grade Ⅳ.Results:Among the 323 patients, there were 20 bilateral hernia cases and 303 unilateral cases. Ninety-seven cases were of scrotal hernia. Surgical methods included 11 TAPP cases, 10 TEP cases, 297 Lichtenstein cases, 3 open suture repair and 2 laparoscopic suture repair. Four cases underwent intestinal resection and in two cases enterostomy was performed. The median follow-up after surgery was 3 months. Hernia recurrence was found in 2 cases, seroma in 14 cases, chronic pain in 2 cases, SSI in 11 cases, intestinal obstruction in 1 case, urinary retention in 3 cases, pulmonary infection in 9 cases, urinary tract infection in 2 cases, cardiovascular and cerebrovascular accidents in 2 cases. The incidence of postoperative complications in the emergency group was significantly higher than that in the elective group. Three deaths occurred within 30 days after surgery, all of which were in the emergency group.Conclusions:Selective inguinal hernia repair is safe and effective for over 85 year old patients with inguinal hernia. The incidence of emergency surgical complications and mortality is significantly increased. Lichtenstein surgery under local anesthesia or regional block anesthesia is the preferred method.

Modern abdominal wall hernia repair has evolved into a systematic engineering project aimed at "functional abdominal wall reconstruction", the success of which largely depends on the deep integration of autologous tissue reconstruction and mesh reinforcement. As the foundation of repair, autologous tissue reconstruction involves meticulous anatomical restoration, tension-control techniques (e.g., component separation technique, transversus abdominis release), and neurovascular protection to restore the integrity of the abdominal wall's layered structures, thereby creating optimal conditions for mesh reinforcement. The selection of mesh materials should follow individualized principles: large-pore lightweight polypropylene mesh is preferred in clean surgeries to achieve a balance between mechanical support and biocompatibility; in contaminated or infected environments, biological meshes, owing to their inherent anti-infection properties and regenerative potential, become the optimal choice for such patients; and for massive defects, a combination of tissue separation techniques and composite mesh strategies is required to balance mechanical demands and biological infection risks. A well-designed repair plan should comprehensively consider patient factors (comorbidities, age), characteristics (size of defect, contamination level, abdominal wall condition), and surgical approach (mesh placement layer), achieving synergistic restoration of anatomical structure, mechanical force distribution, and physiological function, ultimately improving long-term patient outcomes.

Objective:To investigate the long-term efficacy, safety and prognostic factors of intraoperative radiotherapy (IORT) for narrow-margin (resection margin < 1 cm) hepatectomy in patients with hepatocellular carcinoma (HCC) during radical surgery.Methods:A retrospective cohort study was conducted. The data of primary HCC patients undergoing radical surgery and narrow-margin hepatectomy IORT in the Cancer Hospital of the Chinese Academy of Medical Sciences from November 2009 to February 2019 were collected. IORT applied 6 MeV or 9 MeV electron beams and a single irradiation was given to the margin. Kaplan-Meier method was used for the overall survival (OS) and disease-free survival (DFS) analysis; log-rank test was used for survival comparison among subgroups. The recurrence patterns and adverse reactions were recorded. Univariate and multivariate Cox proportional hazards models were used to analyze the factors influencing the OS and DFS.Results:A total of 64 patients were enrolled, with the median age [ M ( Q1, Q3)] of 57 years (49, 63) years. All patients included 55 males (85.9%) and 9 females (14.1%). The median dose of IORT was 15 Gy (range: 12-17 Gy). The median follow-up time was 83.3 (64.4, 91.9) months. The 1-year, 3-year, 5-year, 7-year, 10-year OS rates were 90.4%, 80.6%, 75.5%, 71.4% and 47.6%, respectively; the 1-year, 3-year, 5-year, 7-year,10-year DFS rates were 77.8%, 68.1%, 59.6%, 57.6% and 38.4%, respectively. Univariate Cox regression analysis indicated that preoperative serum alpha-fetoprotein (AFP) > 400 ng/ml was an independent risk factor for poor OS (> 400 ng/ml vs. ≤ 400 ng/ml: HR = 6.57, 95% CI: 2.16-19.96, P < 0.001), while not the independent influencing factor of poor DFS ( HR = 1.71, 95% CI: 0.65-4.52, P = 0.277). The age ≤ 60 years or not, gender, viral hepatitis or not, American Joint Committee on Cancer stage, tumor diameter (> 5 cm or not), tumor number, degree of tumor differentiation, microvascular invasion or not, microsatellite nodules or not, anatomical liver resection or not, and the dose of IORT ≤15 Gy or not were not the independent influencing factors of poor OS and DFS (all P > 0.05). Kaplan-Meier method analysis showed that patients with preoperative serum AFP ≤ 400 ng/ml (48 cases) had better OS compared with those with preoperative serum AFP>400 ng/ml (16 cases) (5-year OS rate: 84.8% vs. 44.9%; 7-year OS rate: 79.9% vs.37.4%), and the difference was statistically significant ( P = 0.002). There was no statistically significant difference in the DFS between the 2 groups ( P = 0.134). During the follow-up, 28 patients (43.8%) relapsed, including 17 cases (26.6%) of early recurrence and 11 cases (17.2%) of late recurrence. No marginal recurrence was observed. There were 22 cases (34.4%) of intrahepatic recurrence alone, 2 cases (3.1%) of extrahepatic recurrence and 4 cases (6.3%) of stimutaneous recurrence inside and outside the liver. The 1-, 3-, 5- and 7-year cumulative recurrence rates inside the liver were 19.0%, 27.2%, 37.4% and 39.3% respectively, and the cumulative recurrence rates outside the liver were 6.4%, 8.0%, 9.6% and 9.6% respectively. There were no adverse reactions above grade 3 in the entire group. There were no surgery-related deaths within 30 d after the operation, and no radiation-induced liver disease occurred. Conclusions:Narrow-margin IORT helps HCC patients receiving hepatectomy to achieve favorable long-term survival and adverse reactions are tolerable. It can be used as a safe and effective adjuvant therapy alternative.

This article provided an overview of the basic concepts and historical development of hernias.The introduction of the concept of"tension-free hernioplasty"marked a milestone in hernia surgery,while the establishment of the concept of"abdominal domain"has propelled its development.This article introduced the introduction and promotion of hernia repair techniques in China,with a focus on discussing the stages of development for Chinese hernia surgical repair techniques including open surgery,laparoscopic surgery,robotic surgery,as well as the application and development of minimally invasive techniques.It emphasized that surgical methods should be selected based on the classification of abdominal wall hernia and the 3R(repair,reconstruction,restoration)principle for abdominal wall reconstruction.Additionally,this article explored advancements in materials science and the promotion of day surgery models.

The only curative method for abdominal wall hernias or defects,such as incisional hernia,traumatic abdominal wall hernia,and abdominal wall defect following the resection of malignant tumor,is surgical repair and reconstruction.Various repair and reconstruction techniques have undergone numerous advancements,leading to the emergence of new methods such as tissue structure separation,transversus abdominis release,and laparoscopic retromuscular or preperitoneal techniques.However,due to factors such as patient variability,the surgeon's technical experience,and materials,treatment outcomes are often suboptimal.Thus,the repair and reconstruction of abdominal wall defects,particularly complex abdominal wall hernia,remain challenging issues in the field of hernia and abdominal wall surgery.As a key factor in the development of hernia and abdominal wall surgery,material science is closely linked to the choice of repair and reconstruction methods.In recent years,advancements in material science have been rapid,evolving from simple structural tissue repair to the ultimate goal of achieving unified abdominal wall structure and function.The requirements for material properties have also shifted from mechanical strength to functional regeneration.The continuous pursuit of technical innovation will remain a focal point for hernia and abdominal wall surgeons for the foreseeable future.