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.

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.

Reviewing the development of hernia and abdominal wall surgery, at the begin-ning, they were only used in simple repair, effects of which were unsatisfactory. Hernia treatment has made a milestone progress with the development of repair materials. Repair materials (Mesh patches) have been applied to various types of abdominal hernia. As surgeons gradually realized the importance of abdominal wall layer in the treatment of abdominal wall defects, they began to pay attention to abdominal wall reconstruction, and applied repair materials to reinforce the abdominal wall, so that the treatment of abdominal wall dysfunction (huge incisional hernia and complex abdominal hernia) has made great progress. Subsequently, surgeons and scientists put forward a new concept "functional repair of the abdominal wall" for the repair of abdominal hernia. An ideal functional repair can restore the function of the abdominal wall, and ultimately achieve the unity of structure and function. The authors discuss the development of the treatment of abdominal hernia from repair, reconstruction to functional restoration.

Acute hernia, as one of the common diseases received in emergency surgery, is characterized by insufficient patient attention and a high incidence of underlying diseases. Therefore, standardized and professional clinical diagnosis and treatment processes are of great significance for improving the prognosis of such patients. Although Chinese hernia specialists have made remarkable achievements in the professionalization of hernia disease over the past two decades through unremitting efforts, there are still certain shortcomings in the standardized diagnosis and treatment, specialized development, and especially in the current emergency diagnosis and operation mode in China. The lack of professional emergency hernia physicians, insufficient disease awareness, and other issues often require negotiation and resolution from both management and professional perspectives to jointly explore an effective green channel for the treatment of acute hernia. A comprehensive and efficient multidisciplinary team should be established to provide effective safety protection for the majority of hernia patients.

Objectives:To investigate the clinical value of a novel non-crosslinked biological mesh in laparoscopic inguinal hernia repair.Methods:The prospective randomized controlled study was conducted. The clinical data of 50 adult patients with unilateral inguinal hernia who were admitted to 3 medical centers, including Ruijin Hospital of Shanghai Jiaotong University School of Medicine et al, from September 2019 to March 2020 were selected. Based on random number table, patients were divided into two groups. Patients using the novel non-crosslinked biological mesh in repair surgery were divided into the experiment group and patients using the lightweight, micro-porous, partially absorbable synthetic mesh in repair surgery were divided into the control group. Observation indicators: (1) grouping situations of the enrolled patients; (2) endpoint of the study. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter rank sum test. Count data were described as absolute numbers and (or) persentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non-parameter rank sum test. Repeated measurement data were analyzed using the repeated ANOVA. Taking the recurrence rate of hernia as the basis of efficacy evaluation, according to the intention-to-treat analysis, the confidence interval method (Newcombe Wilson method) was used to conduct non-inferiority statistical analysis of the recurrence rate of hernia between the experiment group and the control group. If the upper limit of 95% confidence interval of the difference of recurrence rate of hernia between the experiment group and the control group is less than 10%, the experiment group is considered to be non-inferior to the control group. Results:(1) Grouping situations of the enrolled patients. A total of 50 adult patients with inguinal hernia were selected for eligibility. There were 44 males and 6 females, aged (60±15)years. All 50 patients were randomly divided into to the experiment group and the control group with 25 cases each. One patient in the control group was not followed up at postoperative month 2, and the rest of 49 patients completed all expected follow-up. No patient in the two groups fell off or were removed. (2) Endpoint of the study. ① The primary endpoint of study. The recurrence rate of hernia was 0 in the experiment group, versus 4%(1/25) in the control group, respectively, showing no significant difference between the two groups ( P>0.05). Results of non-inferiority statistical analysis showed that the 95% confidence interval of the difference of recurrence rate of hernia between the two groups was -19.54% to 9.72%, with the upper limit as 9.72%, which was less than 10%. ② The secondary endpoint of study. There were 2 patients in the control group occurred seroma at postoperative day 14, and none of the rest of patient in the two groups occurred seroma during the follow-up, showing no significant difference in the occurrence of seroma between the two groups ( P>0.05). There was 1 patient in the control group feeling discomfort or foreign body sensation in groin area at postoperative month 2, and none of the rest of patient in the two groups feeling discomfort or foreign body sensation in groin area during the follow-up, showing no significant difference in the feeling discomfort or foreign body sensation in groin area between the two groups ( P>0.05). There was no patient occurred surgical site infection in the experiment group, and there was 1 patient in the control group occurred postoperative skin infection, which had no relationship with mesh. There was no patient in both two groups occurred fever, anaphylaxis and patch related serious adverse reaction during the follow-up. The resting visual analogue scale score, active visual analogue scale score of patients at postoperative 2 days and postoperative 18 months were 0.44±1.00, 1.28±1.46 and 0, 0 in the experiment group, versus 0.40±0.76, 1.28±1.14 and 0.24±1.20, 0.44±1.29 in the control group, respectively. There was a significant difference in the time effect of postoperative active visual analogue scale score of patients between the two groups ( Ftime=10.19, P<0.05). The thickness of the novel non-crosslinked biological mesh before implantation was 0.5?0.7 mm. Two months after operation, results of B-ultrasonic examination in groin area of 10 patients from the experiment group showed a strong echo area at the patch implant area with a thickness as 2 mm. Conclusion:Application of novel non-crosslinked biological mesh in laparoscopic inguinal hernia repair is safe and effective.

Objective:To study the learning curve in laparoscopic left lateral hepatic sectionectomy.Methods:The clinical data of 62 consecutive patients who underwent left lateral hepatic sectionectomy by a single operator from February 2015 to May 2022 in General Hospital of Northern Theater Command were retrospectively analyzed. There were 22 males and 40 females, with mean ±s.d. of (50.7±11.7) years. The learning curve was depicted and evaluated by using the cumulative summation test. The general information, operation and postoperative indicators of the growth level group and the master level group were compared.Results:The average operation time of the 62 consecutive subjects was (172.9±70.1) minutes. Intraoperative blood loss was 100 (50, 200) ml. Two patients were converted to open hepatectomy. Clavien-Dindo grade I postoperative complications occurred in 20 patients (32.3%), with grade Ⅱ in 1 patient (1.6%) and grade Ⅲb in another patient (1.6%). The learning curve reached its highest point on the 20th patient by using the cumulative summation test. The study subjects were then assigned into the growth level group (patient 1-20) and the master level group (patient 21-62). The master level group had a significantly wider spread of patient age [(52.9±11.0) years vs (46.1±11.9) years], decreased operation time [(146.8±55.6) min vs (227.9±66.7) min], shortened drainage tube removal time [4(3, 5) d vs 6(4, 7) d] and decreased postoperative hospital stay [5(5, 7) d vs 6.5(4, 9) d] (all P<0.05) when compared with the growth level group. Conclusion:Left lateral hepatic sectionectomy was safe and feasible, and a single operator went through a learning curve of 20 patients before he/she could master the operation more proficiently.