Observational studyHernia : the journal of hernias and abdominal wall surgery2026
Time distribution and intraoperative workflow in complex midline incisional hernia repair.
Observational study in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOperative time in complex ventral hernia repair is influenced by multiple patient-, hernia-, and procedure-related factors. However, total operative duration provides limited insight into how time is distributed across individual steps of the operation and which phases contribute most to variability.
methodsThis observational cohort study included 93 consecutive patients undergoing open complex ventral hernia repair with abdominal wall reconstruction. The operation was divided a priori into seven predefined workflow phases comprising seventeen detailed operative segments. Total operative time and phase-specific durations were recorded prospectively. Time distribution and variability were assessed using descriptive statistics and coefficients of variation. Associations between operative time and patient-, hernia-, and procedure-related factors were analysed using non-parametric tests and multivariable regression.
resultsThe median total operative time was 167 min (IQR 145–194). Retromuscular dissection with posterior component separation accounted for the largest proportion of operative time. Adhesiolysis and posterior component separation demonstrated the greatest variability, whereas mesh placement, hemostasis, and final closure phases showed low variability. Larger hernia defect area, hernia recurrence, and bilateral transversus abdominis release were significantly associated with longer operative time. In multivariable analysis, defect size, recurrent hernia, and bilateral posterior component separation remained independently associated with prolonged operative duration, while body mass index was not.
conclusionsOperative time in open complex ventral hernia repair is driven primarily by a limited number of highly variable intraoperative phases rather than uniform prolongation of the entire procedure. Phase-based workflow analysis provides a structured benchmark for operative planning, process optimisation, and future comparisons with emerging surgical technologies.
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