Enhancing laparoscopic inguinal hernia repair with three-dimensional computed tomography reconstruction

Abstract

Zhang et al highlighted the importance of three-dimensional computed tomography reconstruction and myopectineal orifice measurement in laparoscopic inguinal hernia repair. Their findings indicated that preoperative three-dimensional computed tomography provides precise anatomical mapping, allowing surgeons to optimize mesh selection and reduce recurrence rates. Recent studies have corroborated these results, demonstrating that a personalized mesh size based on myopectineal orifice dimensions leads to superior patient outcomes. This article discusses the clinical significance of these advancements in hernia surgery, and emphasises their impact on improving precision, reducing complications, and optimizing surgical planning.

Key Words: Inguinal hernia; Myopectineal orifice; Three-dimensional computed tomography reconstruction; Laparoscopic surgery; Surgical planning

Core Tip: Three-dimensional computed tomography reconstruction offers significant advantages in laparoscopic inguinal hernia repair by enabling accurate preoperative measurement of the myopectineal orifice. This allows surgeons to select mesh sizes tailored to each patient’s unique anatomy, thereby reducing the risk of recurrence, minimizing complications such as chronic pain, and improving surgical outcomes. Recent studies support the routine use of preoperative three-dimensional imaging and highlight its role in advancing personalized hernia surgery, marking a shift away from the traditional one-size-fits-all approach.

TO THE EDITOR

We read with great interest the article by Zhang et al[1] published in recently which presents compelling evidence on three-dimensional (3D) computed tomography (CT) reconstruction and myopectineal orifice (MPO) measurement in optimizing laparoscopic inguinal hernia repair. This study revealed that preoperative imaging provides precise MPO dimensions, thereby facilitating tailored mesh selection and reducing recurrence rates. Given the clinical significance of these findings, we highlight recent studies that further validate our conclusions, and discuss their implications for surgical practice. A primary challenge in hernia repair is to ensure complete coverage of the MPO to prevent recurrence. Zhang et al[1] found that MPO dimensions measured using preoperative 3D CT closely matched the intraoperative findings, thus confirming the reliability of this imaging technique. Recent studies have corroborated these findings, showing that preoperative 3D modelling significantly enhances the precision of surgical planning[2-5]. Hiratsuka et al[3] evaluated the effect of intraoperative MPO measurements on mesh selection in laparoscopic hernia repair and found that customizing the mesh size based on MPO dimensions significantly reduced recurrence rates compared to a standard 10 cm × 15 cm mesh. Similarly, Lee et al[4] reported that extremely large meshes do not further reduce recurrence if the MPO is adequately covered. These results are consistent with the conclusions of Zhang et al[1], who underscored the necessity for a precise MPO assessment. Traditionally, a fixed-size mesh has been used for hernia repair. However, recent research has indicated that the one-size-fits-all approach is suboptimal. Wang et al[5] explored a 3D-printed patient-specific mesh based on CT-derived MPO measurements, and reported improved mesh integration and fewer postoperative complications. These findings suggest that preoperative imaging may guide mesh sizing and customization, thereby reducing the risk of foreign body sensations and chronic pain. Moreover, the integration of artificial intelligence into 3D CT analysis can further enhance surgical precision by automating MPO measurements and optimizing mesh selection. Additionally, the development of bioengineered and 3D-printed patient-specific meshes may improve surgical outcomes. Technological advances may improve the efficiency of hernia repair, reduce recurrence rates, and improve patient recovery. Overall, the integration of 3D CT reconstruction into laparoscopic hernia repair represents a significant advancement in terms of surgical precision. Zhang et al[1] provided strong evidence to support this approach, and recent research further validated its benefits in optimizing mesh selection and reducing the recurrence rate. As more centres adopt preoperative imaging for hernia repair, patient outcomes may improve. We commend the authors for their valuable contributions to this field and encourage further studies to explore personalized surgical strategies based on 3D imaging.