AUTHOR=Pelfini Elisa , Lauricella Sara , Nisi Antonella , Dionigi Gianlorenzo , Brucchi Francesco 
  
TITLE=The ORION study protocol: impact of prior intraperitoneal versus extraperitoneal mesh placement on subsequent minimally invasive abdominal reoperations
  
JOURNAL=Journal of Abdominal Wall Surgery
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2026.17325
  
DOI=10.3389/jaws.2026.17325
  
ISSN=2813-2092
  
ABSTRACT=BackgroundVentral hernia repair is among the most common surgical operations worldwide. Mesh can be positioned in different anatomical planes; extraperitoneal placement is gaining popularity, whereas intraperitoneal placement is linked to long-term complications. Evidence comparing the long-term outcomes of intraperitoneal versus extraperitoneal placement remains limited.ObjectiveThis study addresses that gap, also examining the management of recurrences and the potential neurological sequelae of surgery.MethodsThe ORION study is a prospective, multicentre, observational study involving surgical centres across Europe. The study is addressed to patients who have previously undergone minimally invasive mesh-based ventral hernia repair, with either intraperitoneal or extraperitoneal mesh placement, and who are now undergoing minimally invasive abdominal surgery—either in an elective or emergency setting—for a hernia recurrence (Cohort B) or for other indications (Cohort A). Data will be collected between 1 March 2026 and 28 February 2027. Follow-up assessments at 30 and 90 days are planned only for patients enrolled in Cohort B.DiscussionThe ORION study will provide data on the intraoperative consequences of prior intraperitoneal versus extraperitoneal mesh placement at subsequent minimally invasive abdominal surgery, and will describe recurrence patterns and management among patients reoperated for recurrent ventral/incisional hernia.Clinical Trial RegistrationIdentifier NCT07384962.