Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy
Ventral hernia repair in emergency settings. A machine learning model to predict post-operative complications.
BACKGROUND: Emergency ventral hernia repair remains a challenging procedure due to patient instability, contaminated surgical fields, and heterogeneity in hernia types and operative techniques. Predicting postoperative complications in this setting is difficult using traditional statistical methods. Machine learning (ML) may offer improved predictive accuracy by recognizing nonlinear patterns among multiple perioperative factors. METHODS: A retrospective multicenter analysis was performed using data from the ACTIVE (Acute Treatment for Incisional Ventral Hernias) study, including 557 adult patients undergoing emergent ventral hernia repair between 2018 and 2021 in 31 Italian surgical centers. Demographic, preoperative, intraoperative, and postoperative variables were analyzed. Three ML algorithms-Decision Tree, Random Forest, and Deep Learning Neural Network-were trained and validated using five-fold cross-validation after class balancing with SMOTE. Model performance was compared with traditional logistic regression using accuracy, area under the ROC curve (AUC), and F1 score. RESULTS: Postoperative complications occurred in 181 patients (32.5%), while major complications (Clavien-Dindo ≥ II) occurred in 10%. Random Forest achieved the best performance (AUC 0.95, accuracy 0.88, F1 score 0.86), outperforming logistic regression (AUC 0.82, accuracy 0.78). The most influential predictors were operative duration, ASA score, and sepsis for overall complications, while bowel obstruction and BMI were key factors for major complications. Surgical approach (open vs. laparoscopic) did not independently correlate with adverse outcomes, highlighting the complexity of patient- and case-specific interactions. CONCLUSIONS: Machine learning models can accurately predict postoperative complications following emergent ventral hernia repair, surpassing traditional regression methods. These findings suggest that ML-based decision tools could support risk stratification and optimize surgical planning in high-risk emergency settings. Prospective validation is warranted to integrate AI-assisted prediction into perioperative clinical workflows.
3 Aug 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Open versus laparoscopic repair in pediatric incarcerated inguinal hernia: a systematic review and meta-analysis
PURPOSE: The optimal surgical approach for pediatric incarcerated inguinal hernia remains controversial. This study aimed to systematically compare the clinical outcomes of laparoscopic repair (LH) and open repair (OH) in children with incarcerated inguinal hernia through a systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from database inception to March 2026. Comparative studies evaluating LH versus OH in pediatric incarcerated inguinal hernia were included. Primary outcomes included operative time, intraoperative blood loss, and length of hospital stay. Secondary outcomes included intraoperative injury, wound infection, testicular atrophy, and recurrence. Pooled mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using Review Manager 5.4. RESULTS: Nine studies involving 584 pediatric patients were included in the meta-analysis. Compared with OH, LH was associated with significantly shorter operative time and reduced intraoperative blood loss. The length of hospital stay was also significantly shorter in the LH group. In addition, LH showed a significantly lower risk of intraoperative injury and recurrence. No statistically significant differences were observed between the two groups in terms of wound infection or testicular atrophy. CONCLUSIONS: Laparoscopic repair appears to be a safe and effective alternative to open repair for pediatric incarcerated inguinal hernia. Further high-quality prospective studies are warranted to confirm these findings.
14 May 2026
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