Machine learning (ML) is increasingly applied to predict operative time in surgery, yet its role in robotic ventral hernia repair (VHR) remains unexplored. Brucchi and colleagues recently developed ML models, Random Forest, Gradient Boosting, and Ridge Regression, to predict operative time in 208 patients undergoing elective robotic VHR, achieving modest performance with Random Forest (R[2] = 0.22, MAE = 38 min). While this proof‑of‑concept study represents a novel application, several methodological considerations warrant attention before clinical translation. These include the absence of comparison with traditional statistical methods, the omission of surgeon‑level temporal data and learning curve dynamics, the lack of external validation, and the gap between SHAP‑based interpretability and actionable clinical utility. This Matters Arising offers a perspective on these considerations and proposes directions for future refinement, including incorporation of surgeon‑specific metrics, benchmarking against conventional regression models, external validation, and integration into clinical workflows, to enhance the predictive accuracy and clinical applicability of ML‑based operative time prediction in abdominal wall surgery.

Urinary bladder involvement in inguinal hernias is an uncommon condition, predominantly affecting older men and potentially causing urinary obstruction, infection, and renal dysfunction. We present the case of a 79-year-old man with a six-month history of progressive right inguinoscrotal enlargement, lower urinary tract symptoms, hematuria, and a positive Mery's sign. Laboratory studies revealed renal dysfunction and urinary abnormalities in the setting of suspected urinary tract infection. Computed tomography demonstrated a right inguinoscrotal hernia containing the urinary bladder, with associated bladder wall thickening. Surgical repair was initially deferred to allow clinical optimization and initiation of antimicrobial therapy. Five days later, persistent fever, leukocytosis, worsening urinary findings, flank pain, and persistent systemic inflammatory response despite antimicrobial therapy prompted surgical intervention. The hernia was reduced through a lower midline infraumbilical approach, and primary tissue repair without prosthetic mesh was performed. After antimicrobial escalation, renal function recovered, inflammatory markers decreased, and the patient was discharged without surgical complications. At the two-month follow-up, no hernia recurrence was observed. Bladder-containing inguinoscrotal hernias should be considered in elderly men presenting with inguinal or scrotal masses and lower urinary tract symptoms. Computed tomography is valuable for diagnosis and surgical planning. When urinary infection is suspected or inflammatory findings are present, individualized timing and technique of repair may be appropriate in selected patients according to clinical response and operative findings.

Amyand's hernia is defined as the presence of the vermiform appendix within an inguinal hernia and becomes particularly challenging when appendicitis progresses to perforation and extra-abdominal sepsis. We report a 60-year-old man with one week of progressive abdominal pain, reduced appetite, constipation, and impaired ambulation followed by three days of painful right inguinoscrotal enlargement. Examination showed an irreducible, inflamed right inguinoscrotal mass. Laboratory testing demonstrated leukocytes of 19.35 × 10[3]/µL, neutrophils of 92%, and bands of 13%. Ultrasonography showed a right inguinal wall defect with non-reducing omentum and bowel and complex scrotal contents. Emergency inguinal exploration drained approximately 400 mL of frank purulent material and demonstrated severe ischemic changes of the right spermatic cord and testis. Given the extent of the operative findings, midline laparotomy was performed; a retroperitoneal abscess communicating with the inguinal region and a gangrenous perforated appendix were identified, with the perforation approximately 1.5 cm from the appendiceal base. Appendectomy, retroperitoneal and scrotal drainage, Penrose drain placement, right orchiectomy for nonviability, and Shouldice tissue repair without mesh were performed. Recovery was favorable without known immediate complications. This case illustrates a severe Type III Amyand's hernia with simultaneous retroperitoneal and inguinoscrotal septic extension and irreversible testicular ischemia. In grossly contaminated presentations, prompt source control, excision of nonviable tissue, and nonprosthetic hernia repair remain pragmatic priorities.

Parastomal hernia affects up to 30% of patients following ileal conduit urinary diversion, with symptoms developing in one-third and 15% requiring surgical intervention. Known risk factors include obesity, larger fascial defects, chronic obstructive pulmonary disease, and diabetes. Diagnosis relies on clinical examination in addition to computed tomography imaging. Prophylactic mesh placement has shown conflicting results in randomized trials and is currently not universally recommended. For established hernias, Sugarbaker mesh repair offers lower recurrence than Keyhole repair, although the overall recurrence rate remains high. Future work to identify novel preventative and curative approaches is needed.