Abdominal Wall Hernia Research Articles

V-015 ENDOSCOPIC MANAGEMENT OF AN INCARCERATED SPIGELIAN HERNIA

Abstract Introduction Spigelian hernias are abdominal wall hernias (incidence 0.12% to 2%). It is more common in women over the age of 60 years and occurs in individuals with raised intraabdominal pressure or weakening of the abdominal fascial layers. Several studies suggest that about 27% of Spigelian hernia will incarcerate and this will require immediate surgical intervention depending on the presentation. Presentation A 76-year-old lady presented with a painful lump at the right lower abdomen since a few days. No other constitutional symptoms were reported. She denied any comorbidities and was on no medication that would contraindicate a general anaesthetic. On Examination she had a 2cm tender non reducible lump at the right Spigelian line. A CT scan revealed a break in the right side of the abdominal wall consistent with a Spigelian Hernia. She underwent a repair using a laparoscopic, totally extraperitoneal technique (TEP). This was undertaken as a day case surgery with the hernia containing extraperitoneal fat only. The video demonstrates surgery with balloon dissection, medial to lateral dissection displaying the ilio-pectineal (cooper's) ligament and reduction of the hernia. The defect was covered with a mesh and fixated with Tisseel fibrin sealant. On her 4th week outpatient follow up she recovered well with only a small seroma at the previous site of the Spigelian hernia. Conclusion Our video demonstrates an efficient way to perform a Laparoscopic totally extraperitoneal (TEP) technique for an incarcerated Spigelian Hernia.

OC-094 LESSONS LEARNT FROM DEVELOPING AN ABDOMINAL WALL RECONSTRUCTION (AWR) MULTIDISCIPLINARY TEAM (MDT) IN A COMPREHENSIVE HERNIA CENTRE

Abstract We present our experience of developing a successful AWR MDT in a Tertiary Referral Centre, which aimed to optimise the management of complex AWR patients. The weekly AWR MDT was established in August 2020. Cases are discussed with a hollistic approach. A comprehensive individualised plan is agreed regarding appropriateness of surgery, pre-operative risk factors requiring optimisation and operative specific decisions. 151 patients have been discussed to date (118 incisional hernias, 33 primary). In 65% of patients, at least one risk factor for adverse surgical outcomes was identified that required pre-optimisation, most commonly the need for weight loss (93%), glycemic control (22%), & smoking cessation (22%). 50 patients have been operated on to date. Retrorectus repair was the most commonly used technique (86%). Adjuvant techniques such as peritoneal flaps were suggested in 36% of patients. 23 patients are currently on waiting list for surgery, 45 remain in their prehabilitation period. 20 patients did not undergo surgery after combined patient and MDT decision. 8 patients await further investigation and 5 patients have been transferred to other centres due to specialist input requirement. MDT management of abdominal wall hernias remains poorly established in most regions. Our experience highlights how vital it is. We have proven that it is feasible to run MDTs and that it has improved pre-operative planning and focus on modifiable risk factors in our centre. We would encourage other centres to establish this for complex cases, so that the most appropriate decisions can be made for this surgically challenging group.

V-012 MADRID-PCS. STEP BY STEP E-TEP APPROACH

Abstract Aim To show the steps involved in the Madrid Modification of posterior component separation (PCS) by e-TEP approach. Material and Methods We present a case of a patient with a lateral incisional hernia (L3W1) associated with primary umbilical hernia and ipsilateral groin hernia. The repair that allows treatment of all defects and wide prosthetic coverage with wall reinforcement is PCS, performed in this case according to the Madrid modification. Due to the presence of risk factors for surgical site occurrences such as obesity, we decided to perform a totally extraperitoneal minimally invasive approach (e-TEP) and the step-by-step procedure is shown. Conclusions Minimally invasive surgery has become the standard approach in many abdominal wall pathologies. Since the description of the e-TEP technique in 2017, its growth and development has been exponential, progressively expanding for large defects and other locations; being especially indicated versus open surgery for patients with risk factors for surgical site events. Likewise, the technique of PCS described in 2012 by Novitsky has been extended in recent years and is now the gold standard in the treatment of complex abdominal wall hernias. From the Madrid group, modifications to this technique have been proposed. We present a video that combines this modification with minimally invasive surgery, visualizing the steps of this technique using the e-TEP approach.

OC-051 CAN ETEP APPROACH IMPROVE COMPLEX INCISIONAL HERNIA REPAIR OUTCOMES?

Abstract Aim To compare postoperative results of two cohorts of patients with simple and complex incisional hernias, operated using the extended totally extraperitoneal technique (eTEP). Materials and Methods Retrospective comparative multicenter study based on prospective database conducted at the Fundación Jiménez Díaz University Hospital and La Paz Hospital in Madrid, including eTEP repairs performed between March 2019 and January 2023. Patients were classified as complex hernias if they met at least one criterion according to the Slater definition (1). If no criteria were met, it was classified as a simple hernia. Results 159 patients were operated on via eTEP during the study period, and 111 incisional hernias were analyzed according to the EHS classification: 38 complex cases and 73 simple cases. The median defect size was 50mm (40–97) in simple cases and 66mm (24–126) (p<0.01), the median surgical time was 130min (59–360) and 145min (63–240) respectively without significant differences. TAR was required in 26 (35.6%) simple cases versus 23 (60.5%) complex cases (<0.01). One (1.4%) recurrence was observed in simple cases and 2 (5.3%) in complex cases, as well as 7 (9.6%) complications in simple cases and 5 (13.2%) in complex cases, both without statistical significance. The median follow-up was 26 months in simple cases and 11 months in complex cases (p<0.01). Conclusions The application of the eTEP approach in selected complex cases can improve postoperative results close to simple hernias. 1. Slater NJ et al. Criteria for definition of a complex abdominal wall hernia. Hernia 2014, 18:7–17.

OC-021 TRANSVERSUS ABDOMINIS MUSCLE RELEASE FOR THE TREATMENT OF COMPLEX BILATERAL SUBCOSTAL INCISIONAL HERNIAS

Abstract Aim To assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. We present our results of posterior component separation through the previous incision as a safe and reproducible technique for complex cases. Material & Methods A multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020 was gathered. The outcomes reported were short and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. Results A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 (15%) requiring procedural intervention. During a mean follow-up of 18 months (range, 6–62 months), 1 (2%) case of clinical recurrence was registered. Also, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 variables (pain, restriction, and cosmetic) of the postoperative scores compared with the preoperative score. Conclusion Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patient's reported outcomes.

P-097 FEMORAL AND OBTURATOR HERNIA INCARCERATED: A CASE REPORT

Abstract Obturator hernia is a very rare type of abdominal wall hernia, accounting for less than 1% of all abdominal wall hernias. They can be confused with femoral hernias as well as they can arise simultaneously, just like in this clinical case. A 82 year old female, with multiple comorbidities including a right inguinal hernioplasty, was brought to our emergency department complaining of abdominal pain, distension and vomiting in the last 24 hours. On physical examination, there where abnormally active, high-pitched bowel sounds, abdominal distension and pain on left lower quadrant but no tenderness. Palpation of groin area showed an incarcerated left femoral hernia, apparently containing only omentum. As the patient maintained left lower abdominal pain, we proceed to a CT scan, which demonstrated small bowel dilation with air-fluid levels consistent with a small bowel obstruction originating from an obturator hernia. Open tension-free mesh repair of femoral hernia was done and no need for ressection since it only contained omentum, without ischemic signs. Open transperitoneal nonmesh repair of obturator hernia was performed after hernia reduction. There was no irreversible ischemia. Evolution during hospitalization was uneventful. Regarding obturator hernias, there is no optimal approach since it is a very rare type of hernia, so it probably depends on patient condition and surgeon experience. A transperitoneal approach is preferred when there's signs of bowel obstruction, as we proceed on this clinical case.

V-026 LAPAROSCOPIC TAPP REPAIR: IS IT REALLY FEASIBLE IN A RE-RECURRENT HERNIA?

Abstract Aim Describe a step by step laparoscopic transabdominal preperitoneal (TAPP) repair of a re-recurrent incisional lumbar hernia. Material & Methods This is the case of a 72-year-old man who had a previous traumatic right lumbar hernia initially approached by laparoscopic intra-peritoneal onlay mesh repair (IPOM) and its recurrence approached by open onlay mesh repair. CT-scan revealed a lumbar hernia on the right with a neck size of 40 mm. The hernia sac measured 65 mm and contained part of the right colon inside, without signs of incarceration nor dilated intestinal loops. According to the European Hernia Society classification for incisional abdominal wall hernias, the patient had a lateral hernia (L4 W2). Results Lateral incisional hernias are limited by the inguinal region inferiorly, the costal margin superiorly, the lateral margin of the rectal sheath medially and the lumbar region laterally. Due to their low incidence and the resulting lack of expertise in the treatment of this abdominal wall defect, surgical treatment poses a challenge- Conclusion The repair of a recurrent hernia is a daunting task, even more so of a re-recurrent one. By choosing to perform a TAPP repair, we were able to prove a laparoscopic re-do repair is feasible even faced with weakened tissues and distorted anatomy.

P-058 In the path of a hernia center?

Abstract Introduction and aim Hernia surgery is becoming more complex and demanding, increasing the need for specialization. Certification of units dedicated to hernia surgery must follow some requirements linked to surgical skills, resources, and outcomes. We aim to analyze the outcomes and benefits of a dedicated hernia unit. Methods We conducted a retrospective analysis of 333 abdominal wall hernia repairs performed from the start of a dedicated unit in 2020, until 2022. A total of 187 patients underwent groin hernia repair, 70 primary ventral and 75 incisional hernia. Demographic and clinical data, surgical techniques, and outcomes were assessed. The results were analyzed according to the accreditation and certification requirements for hernia centers and surgeons from European Hernia Society. Results The group performed 124 open and 63 laparoendoscopic groin hernias, 50 open and 20 laparoendoscopic primary ventral hernia, and 36 open and 39 laparoendoscopic incisional hernias. The total complication rate for groin hernia surgery, 30 days postoperatively, was 2,7% (< 5%) (1,6% wound dehiscence, 1,1% seroma, 0% pulmonary or cardiovascular), reoperation rate was 0% (<2%), recurrence 1,6%, and chronic pain 2,15%. In primary ventral repair, the morbidity within thirty days was 1,4%, infection was 1,4% and recurrence 0%. According to incisional hernias, the infection/revision rate after open surgery was 11/% (>10%), after laparoscopic surgery was 2,5% (<3%) and the reoperation rate was 0,5% (<10%). Conclusions Optimal results in hernia surgery can only be guaranteed in dedicated units that follow a “tailored-approach” concept, yet need expert hernia surgeons with increasing knowledge and experience.

OC-030 COMPARISON OF OUTCOMES OF THE EXTENDED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA (ETEP-RS) AND THE INTRAPERITONEAL ONLAY MESH WITH DEFECT CLOSURE (IPOM-PLUS) FOR W1-W2 MIDLINE INCISIONAL HERNIA REPAIR

Abstract Aim This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon. Material and Methods Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24 months in the eTEP-RS group and 45 months in the IPOM-plus group. Results There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. The mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (p <0.001 and p =0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48 days vs. 2.58 days, p <0.001) and pain on the first and 10th postoperative days were significantly lower (p <0.001), while the operative time was significantly longer (p <0.001). There was no significant difference in terms of intraoperative complications (p =0.56), seroma formation (p =0.83), or recurrence (p =0.83). Conclusions The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.

OC-096 Short-Term Results of Transversus Abdominis Release in Patients under Immunosuppression

Abstract Aim Immunosuppressive medication might increase the likelihood of wound morbidity, with possible higher rate of surgical site infections (SSIs). We aim to identify short-term outcomes and hospital stay after incisional hernia repair with transversus abdominis release (TAR) in patients with versus without immunosuppression. Material & Methods All patients undergoing open incisional abdominal wall hernia repair with uni-or bilateral TAR from January 2021 through November 2022 were identified using a prospectively maintained database. Minimum follow-up was 30 days. Outcomes included 30-day SSIs, seroma rate, hospital stay, and early recurrence. Results Twenty-seven patients with immunosuppressive medication were identified and 75 without (mean age 59.0 ± 13.9 vs. 65.1 ± 11.4, 74.1% vs. 46.7% male, respectively). Median hernia width was 7.7 ± 5.1 cm vs. 7.9 ± 4.3 cm respectively. At 30 days follow-up, SSI rate was 1/27 (3.7%) in the group under immunosuppression and 5/75 (6.7%) in the group without (p = 0.575). Seroma rate was 3/27 (11.1%) vs. 12/75 (16.0%), respectively (p = 0.539). Mean hospital stay was 6.0 ± 3.6 days in the immunosuppression group vs 8.1 ± 6.7 days in the group without (p = 0.052). No early recurrences were detected in either group. Conclusion Immunosuppression does not significantly increase the risk of short-term complications in incisional hernia repair with transversus abdominis release. There is a trend towards a shorter hospital stay in patients under immunosuppression, possibly related to a reduced inflammatory response.

P-025 TREATMENT OF UMBILICAL HERNIA IN A COOPERATION PROJECT IN TANZANIA

Abstract Aim Adult umbilical hernia accounts for between 3% and 14% of abdominal wall hernias, second only to inguinal hernias in frequency. The current prevalence of umbilical hernias in Africa is currently unknown, but it is estimated that about 50,000 patients die each year in Africa as a result of umbilical hernias. We describe below the number of interventions performed in 2022 by European aid workers in a third level Hospital in Tanzania using local anesthesia and the available material. Material and Methods We performed a retrospective observational study of the number of umbilical hernias operated in a Third level Hospital in Tanzania Results Throughout 2022, 2818 surgical interventions were performed in men and women by european aid workers: 114 interventions (4.04%) were umbilical hernia repairs. The age range of the operated patients was 12–18 years. No mesh was used in any case. The techniques used consisted of edge-to-edge closure. Patients were discharged after 24–48 hours without complications and no follow-up was obtained due to the fact that it was a rural hospital. Conclusions Umbilical hernia repair with mesh is the gold standard of treatment in our environment, however its practice in collaborative projects of this type requires a thorough knowledge of non-prosthetic repair options due to the scarcity of material.

OC-123 COMPARISON OF COMPLICATION RATES BETWEEN INTRA- AND EXTRAPERITONEAL HERNIA REPAIRS

Abstract Aim With the emergence of new laparoscopic techniques, Intra-Peritoneal-Onlay-Mesh (IPOM) has fallen out of favor for repairing abdominal wall hernias due to reported complications, including adhesions and bowel injury, our aim is to compare complication rates in our center between intra- and extraperitoneal techniques. Material & Methods A retrospective analysis was conducted on data from our certified hernia center from 2018 to 2021. All patients who underwent an umbilical, epigastric or incisional hernia-repair were included. The primary outcome measures were complications, including bowel injury and adhesions. Results A total of 188 patients underwent a hernia repair. 74 (39%) patients hat an umbilical hernia, 22 (12%) an epigastric hernia and 92 (49%) had an incisional hernia. Most patients (110–58%) were treated with laparoscopic IPOM, 14 (7,4%) of them underwent an open IPOM. 46 (25%) had hernias repaired with direct suture and the remaining patients were treated with other techniques, including open sublay and mini or less open sublay (MILOS). After an average follow-up of 36months, only two (1%) patients developed a mechanical ileus, one after laparoscopic and one after open IPOM surgery. Bowel lesions occurred in two (1%) patients who underwent open IPOM and direct suture hernia repairs. There was no difference in complications between the different surgical techniques. Conclusion Our study suggests that the different techniques for hernia repair have similar rates of complications. Further research is needed to determine the most effective and safe approach for hernia repair.

BJS-07 COMPARISON OF ENDOSCOPIC ENHANCED-VIEW TOTALLY EXTRAPERITONEAL PROSTHETIC (ETEP) VERSUS OPEN RIVES-STOPPA REPAIR AS TREATMENT OF MIDLINE ABDOMINAL WALL HERNIAS WITH RECTUS DIASTASIS: SINGLE-CENTRE SURGICAL COHORT

Abstract Aim The Rives-Stoppa (RS) procedure is a gold standard in the treatment of midline abdominal wall hernias. Comparability of pain control and outcomes to the less invasive enhanced-view totally extraperitoneal prosthetic (eTEP) repair remain unclear. Material & Methods Single centre surgical cohort including 30 RS repairs (January 2019 – November 2021), and 30 consecutive eTEP procedures (September 2021 – August 2022) for midline abdominal wall hernia(s) with rectus abdominis diastasis. Postoperative pain and outcomes were compared. Results Presence and median duration of patient-controlled analgesia (PCA) were respectively 90% and 3 nights with RS, versus 30% and 0 nights with eTEP. Median switch to only oral analgesics occurred at postoperative day (POD) 3 after RS and at POD 2 after eTEP. Postoperative analgesics and opioid prescription at discharge were comparable between groups. Median length of hospital stay was 6 nights after RS versus 3 nights after eTEP. Median duration of surgery was 110.5 and 164.5 minutes for RS and eTEP respectively. After RS, 30 patients had a postoperative drain compared to 3 patients after eTEP. Conversion was needed in 3 eTEP procedures. Postoperative complications were comparable. No early recurrences were observed. Minimal residual diastasis was observed at postoperative consultation in 11 patients after eTEP. Conclusions eTEP is a feasible minimally invasive alternative to RS for the treatment of midline abdominal wall hernias with rectus abdominis diastasis and is associated with a shorter length of hospital stay, less postoperative pain and a comparable risk of short-term complications. Registration number: NCT05446675 (ClinicalTrials.gov).

OC-129 A new surgical technique for repair of rectus diastasis and associated hernia: description and initial experience

Abstract Aim Rectus diastasis (RD) is a common pathology, usually associated with midline hernias. Preaponeurotic surgical repairs have been described with complications derived from extensive subcutaneous dissection or suprafascial mesh placement. Other techniques place preperitoneal mesh but midline plication is not performed, with aesthetic disadvantages. We describe a new technique for the correction of ventral hernias associated with RD with midline plication and preperitoneal mesh (MPPM) and report our initial experience. Material and Methods We reviewed patients with RD and associated hernia surgically treated using the MPPM technique at our hospital from June 2021 to July 2022. The minimum follow-up time was 6 months. Results Forteen patients with RD and associated hernia were surgically treated with MPPM technique, with an average age of 64.1 years (range 38–82 years), 71.4% male and 28.6% female. The mean BMI was 28.8 Kg/m2 (range 18.6–40.0 Kg/m2). Three women (21.3%) had a mean of 1,3 previous pregnancies (range 0–2 pregnancies). The most common types of associated hernia with RD were primary midline hernia (50%), incisional hernia (21.4%), and recurrent midline hernia (28.6%). Half of the RD (50%) were M1-3 and the other half M2-3 (50%) as well as W1 (50%) and W2 (50%). The mean diameter of associated hernia was 3,2 cm (range 1–6 cm). Hematoma was observed in one patient (7,1%) in the first 30 postoperative days. No reccurence was recorded in the follow-up time. Conclusions The MPPM technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with RD.

V-009 Robot-Assisted Repair of a Traumatic Hernia After a Pelvic Fracture: Case Report and Literature Review

Abstract Aim Traumatic abdominal wall hernias (TAWH) are an uncommon clinical entity, accounting for less than 0.2% of all blunt trauma injuries. Management and operative technique are still a matter of debate and the role of the robotic surgical platform in traumatic hernias has not been reported on. We present a robot-assisted repair of a TAWH through a fracture of the left iliac wing. We aim to describe our operative approach and perform a review of the literature. Material and methods A 46-year-old male with a history of a high energetic trauma presented with a symptomatic swelling in the left lumbar region. Further imaging showed an important defect of the abdominal wall caused by a disruption of the iliac and gluteus muscles and non-union of a left iliac wing fracture. This caused a herniation of the descending colon. A robot-assisted transabdominal preperitoneal hernia repair (TAPP) with synthetic mesh was performed in elective setting. Results The postoperative course was uneventful. Discharge was possible at postoperative day one. There was no surgical site infection, seroma, or recurrence after a follow-up period of 6 months. Conclusions To our knowledge, we describe the first robot-assisted repair of a TAWH through a pelvic fracture. Our technique was safe and feasible. In difficult to reach areas of the abdomen, a robot-assisted repair might be a valid approach. Larger studies are needed to confirm our initial experience in traumatic abominal wall hernia surgery.

Blunt Traumatic Abdominal Wall Hernias: An Indicator for Emergent Laparotomy?

Traumatic abdominal wall hernias (TAWH) are relatively uncommon; however, the shearing force that results in fascial disruption could indicate an increased risk of visceral injury. The aim of our study was to evaluate whether the presence of a TAWH was associated with intra-abdominal injury requiring emergent laparotomy. The trauma registry was queried over an 8-year period (7/2012-7/2020) for adult patients with blunt thoracoabdominal trauma diagnosed with a TAWH. Those patients who were identified with a TAWH and greater than 15years of age were included in the study. Demographics, mechanism of injury, ISS, BMI, length of stay, TAWH size, type of TAWH repair, and outcomes were analyzed. Overall, 38,749 trauma patients were admitted over the study period, of which 64 (.17%) had a TAWH. Patients were commonly male (n = 42, 65.6%); the median age was 39 years (range 16-79years) and a mean ISS of 21. Twenty-eight percent had a clinical seatbelt sign. Twenty-seven (42.2%) went emergently to the operating room, the majority for perforated viscus requiring bowel resection (n = 16, 25.0%), and 6 patients (9.4%) who were initially managed nonoperatively underwent delayed laparotomy. Average ventilator days was 14days, with a mean ICU LOS of 14days and mean hospital LOS of 18days. About half of the hernias were repaired at the index operation, 6 of which were repaired primarily and 10 with mesh. The presence of a TAWH alone was an indication for immediate laparotomy to evaluate for intra-abdominal injury. In the absence of other indications for exploration, nonoperative management may be safe.

The role of laparoscopic IPOM in the treatment of abdominal hernias: lesson learned after 400 surgeries using single mesh.

Abdominal wall hernias and incisional hernias are a common benign disorder affecting quality of life, potentially leading to life-threatening complications. Laparoscopic IPOM (intraperitoneal onlay mesh) approach can offer good results in selected cases. Patients who underwent laparoscopic incisional/ventral abdominal hernia repair operated with standardized technique and the same mesh, from January 2011 to December 2022, were retrospectively considered. Four hundred consecutive patients underwent laparoscopic abdominal wall repair. There were 255 ventral hernia (63%) and 145 (37%) primitive hernia (epigastric and umbilical). Mean size of the defect was 4.2 cm, W3 were 19 (4%). After a mean follow-up of 1906 days (range 45-4109), no mesh-related complications have been detected. There were 10 (2.5%) recurrences and 20 (5%) bulging. In this study we emphasized the role of patient selection and standardized technique which represents "the lesson" learned over a period of 15 years of activity. In this setting, we believe that laparoscopic approach can achieve very good results in abdominal wall repair.

Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study

Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure of surgical techniques may occur. The aim of this study is to analyze results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2014 and December 2021. Fifty-one patients complied with the criteria to be included in this study. We should consider offering surgical treatment for hernia recurrence after retromuscular repair or posterior components separation. However, the results might be associated to increased peri-operative complications.

Are abbreviations and acronyms to describe hernia repair techniques overused and helpful? A proposal for rationalisation

Surgeons use abbreviations and acronyms frequently to describe surgical techniques. Recent advances and innovations in repair of abdominal wall hernias, have given rise to a plenitude of novel acronyms. For each small deviation of an existing technique authors have proposed a novel acronym. Since an acronym is most of times not self-explaining it is often hard to understand literature, lectures, symposia programs and discussions in social media. Regularly, we discover different acronyms used for the same procedure and sometimes the same or similar acronyms are used for different techniques. A clear and non-ambivalent description of surgical techniques in the literature is most valuable to summarize scientific evidence in systematic reviews and meta-analyses.We would like to propose a more rational use of abbreviations to describe hernia repair techniques based on the type of access, type of hernia, mesh position, type of mesh used and type of mesh fixation.

Spiegel's hernia: A case report

Spiegel's hernia is a pathology of rare prevalence and represents less than 0.1% of abdominal wall hernias that corresponds to the protrusion of ́ a peritoneal sac through an acquired or congenital orifice of Spiegel's semi-lunar line. Diagnosis often proves difficult given its peculiar location that is unfamiliar to most primary care physicians in the emergency department. It is often diagnosed at the stage of complication thus making l ́strangulation a circumstance of discovery and then exposing to the sometimes serious consequences of diagnostic delay. We report the case of a 25-year-old man who had presented with the appearance of a painful swelling of the left iliac fossa. The morphological examination was in favor of a left spiegel hernia and the surgical exploration showed a hernia sac with epiploic content without any sign of pain.