Abdominal Wall Incisional Hernia Research Articles

Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction

PurposeThe closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases.MethodsWe reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh.ResultsTwelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8–45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society’s quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01).ConclusionsThe combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.

A new modified technique in complicated umbilical hernia repair in patients with decompensated cirrhosis: a single center Experience

Background Patients with decompensated cirrhosis have a high incidence of abdominal wall hernias with a poor outcome after surgical management. Aim The aim was to evaluate the outcome of a new technique in the repair of complicated umbilical hernias in patients with decompensated cirrhosis. Patients and methods In all, 30 consecutive patients with decompensated cirrhosis underwent herniorrhaphy for complicated hernia and were randomized into two groups: group I (n=15) received the new technique: three-transverse-layer technique with regular paracentesis, first, 5–7 interrupted sutures without tie; second, continuous suture starting 3 cm lateral to the angles, third, tie the previous interrupted suture over the continuous tied suture, fourth, the third layer continuous suture to invaginate the previous sutures (using Proline 1/0 at all), fifth, regular paracentesis. Group II (n=15) received two continuous transverse-layer repair, first, suture started 1 cm lateral to the angle and then completed in a continuous manner till 1 cm after the second angle and tied; second, this was then followed by the second layer continuous suture to invaginate the previous sutures. Results Postoperatively, there were complications in 14 (46.67%) patients in the form of wound infection in three (20%) patients in group I and seven (46.67%) patients in group II with no statistical significance between both groups. Wound dehiscence occurred in five (33.33%) patients in group II only with statistical significance between both groups (P Conclusion The new technique of hernia repair in patients with decompensated liver cirrhosis was associated with a significant reduction in wound ascitic leak, wound dehiscence, hospital stay, morbidity, and recurrence.

Inguinal hernia repair in cirrhotic patients with ascites

AIM: Cirrhotic patients with ascites have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical treatment as well as timing of inguinal hernia repair in this situation remains controversial. In the present study, we aim to address the safe and risk profile of inguinal hernia repair in cirrhotic patients with ascites. MATERIALS AND METHODS: Major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through October 2019 were identified, using the keywords: “inguinal hernia,” “liver cirrhosis,” “ascites,” “hernia repair,” including various combinations of the terms, all relevant articles and reference lists in these original studies were also obtained from the above databases. RESULTS: Nine articles were identified on inguinal hernia repair in cirrhotic patients with ascites. Various anesthetic methods and repair techniques were used to repair inguinal hernia in this situation. The frequent postoperative complications were minor-wound complications, with an overall incidence of 15.4% in elective surgery, which could be managed with conservative treatment. While, emergent surgery was associated with increased wound complications. The recurrence rate was 2.0%, the average of postoperative 30-day mortality was 1.0%, and none of the death was attributable to the complications of inguinal hernia repair and their treatment. CONCLUSION: Elective inguinal hernia repair in cirrhotic ascites is safe and should be advocated. Emergent surgery is associated with increased wound complications. Although the data are insufficient to support a specific technique, mesh repair has advantages with regard to long-term recurrence rate.

INCISIONAL HERNIA IN PREGNANCY A SILENT BUT POTENTIAL FATALITY – CASE REPORT

Rupture of incisional hernia, with consequent emergency laparotomy and repair, is an uncommon complication of pregnancy. The risk to the mother and baby is enormous. We present an un-booked 29 year old G4P2+1 (1- alive) with one previous caesarean section at 29 weeks of gestation. She had a huge anterior abdominal wall incisional hernia with gravid uterus as content. She was admitted on conservative management on account of abdominal pain and preterm contractions, but subsequently developed spontaneous rupture from an ulcer with bowel evisceration. She had emergency laparotomy and repair but unfortunately had unavoidable bowels injury as they were morbidly adherent to the anterior abdominal wall with injury necessitating resection and re-anastomosis with caesarean section. The neonate suffered early neonatal death. The presence of ulceration may be a predictor of adverse maternal and foetal outcome

Correction to: Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))—Part A

This article was updated to include the middle initial of author L. N. Jorgensen's name.

Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)): Part B

In 2014 the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias”. Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature.MethodsFor the development of the original guidelines all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based-Medicine. For the present update all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne) the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included.ResultsDue to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite still insufficient evidence with respect to these new techniques it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields.ConclusionGuidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initially guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.

Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))\u2014Part A

In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature.MethodsFor the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included.ResultsDue to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields.ConclusionGuidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.

Long-term Outcome of Incisional Hernia Repairs Using the Erlangen Inlay Onlay Mesh (EIOM) Technique

BackgroundThe objective of this study was to investigate the long-term outcome of incisional hernias treated with the Erlangen Inlay Onlay Mesh (EIOM) repair technique, taking into account recurrence, complications, and patient satisfaction. MethodsA total of 163 patients treated in the surgical department of Erlangen university hospital with the EIOM repair between the years 1996 and 2009 were evaluated retrospectively. ResultsThe collected data revealed a mean follow-up period of 70 (18-190) months. Incisional hernia recurrence after EIOM repair was observed in 6 (3.7%) patients after a mean observation period of 70 mo (18-190) postoperatively. The recurrence rate increased significantly when the body mass index (BMI) was higher than 32 kg/m2. Here, a recurrence rate of 10.5% for BMI> 32 versus 1.7% with BMI ≤32 was reported. There were no significant differences in hernia recurrence if haven been operated by an assistant under supervision or by a consultant. In regard to patient satisfaction, 91% of patients included in this study were satisfied with the surgical outcome. ConclusionsThe EIOM procedure is a safe surgical technique that can be used for the treatment of all, also for giant incisional abdominal wall hernias regardless of the size, BMI, or position of the incisional hernia.

Clinical value of component separation technology reducing postoperative recurrence after giant abdominal wall incisional herniorrhaphy

How to repair and reconstruct giant abdominal wall incisional hernia effectively, is still a difficult problem for surgeons of hernia and abdominal wall surgery. Component separation technology based on mesh reinforcement provides an excellent method to repair and reconstruct giant abdominal wall incisional hernia in anatomy and function, and possesses an lower recurrence rate than primary suture and bridged mesh repair. Standardized component separation technology plays an important role in improving the therapeutic effect of giant abdo-minal wall incisional hernia. Key words: Abdominal wall incisional hernia, giant; Component separation technology; Repair; Reconstruction; Recurrence

Current status of hernia and abdominal wall surgery and innovation research and development of repairing materials

Nowadays, hernia and abdominal wall surgery developes rapidly in China. Tension-free repair for inguinal hernia and abdominal wall incisional hernia is popular, and laparoscopic and even Da Vinci robotic hernia repair have been promoted rapidly. Due to the unbalanced development in diffe-rent areas of China, there is still existence of irregular diagnosis and treatment in hernia. Registry system of hernia and abdominal wall surgery and quality control standards are urgently needed. A few etiology, genetics and molecular epidemiology studies have been reported, although basic research of hernia is weak in the whole world. The exact pathogenesis and inheritance pattern are worthy of further study. The progress of hernia and abdominal surgery is inseparable from the development of repairing materials. At present, the repairing materials are mainly composed of synthetic materials and biomaterials. Although prosthetic repair can reduce postoperative hernia recurrence rate, mesh related adverse events in the long term should not be ignored, including common complications such as mesh shrinkage, erosion, adhesion, infection and so on. There is no ideal repairing material yet, but the innovative research and development of materials is worthy of the expectation in hernia and abdominal wall surgeons. Key words: Hernia; Inguinal hernia; Incisional hernia; Quality control specification; Repairing material

Clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia

Objective To explore the clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia. Methods The retrospective cross-sectional study was conducted. The clinical data of 41 patients with abdominal incisional hernia who were admitted to the Fujian Medical University Union Hospital between September 2011 and June 2017 were collected. All the patients underwent laparoscopic combined with open mesh repair, with the sequence from laparoscopic surgery to open surgery and then to laparoscopic surgery. Observation indicators: (1) intra- and post-operative situations; (2) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications and hernia recurrence up to November 2017. Measurement data with normal distribution were represented as ±s. Results (1) Intra- and post-operative situations: forty-one patients underwent successful laparoscopic combined with open mesh repair for abdominal wall incisional hernia. Diameter of hernia ring and defect area of abdominal wall were respectively (10±3)cm and (75±34)cm2. Among 41 patients, 25 underwent laparoscopic combined with open mesh repair due to tight intestinal adhesion induced difficult laparoscopic separation; 16 underwent laparoscopic combined with open mesh repair due to the larger diameter of the hernia ring induced difficulty of closing hernia ring under laparoscope. Operation time, cases with indwelling drainage-tube, time of drainage-tube removal and duration of postoperative hospital stay were respectively (188±71)minutes, 33, (14±3)days and (4.5±2.6)days. Of 41 patients, 2 with postoperative incomplete intestinal obstruction were cured by symptomatic treatment; 2 with incisional infection were cured by antibiotic therapy, irrigation and dressing change. (2) Follow-up situation: 41 patients were followed up for (29±17)months. The postoperative chronic pain of 2 patients was occasional and cannot affect the normal life. There was no occurrence of seroma, mesh infection, intestinal fistula, abdominal compartment syndrome and hernia recurrence during the follow-up. Conclusion The laparoscopic combined with open mesh repair has a better clinical effect for patients of incisional hernia with large hernia ring and tight intestinal adhesion, and surgical methods should be chosen seriously according to the condition of the patients in clinical application. Key words: Incisional hernia, abdominal wall; Hernia repair; Mesh repair; Polypropylene mesh; Intestinal adhesion; Incisional hernia, giant; Recurrence; Complications; Laparoscopy

The results of surgical treatment of patients with large and complex incisional hernias of the anterior abdominal wall in a multidisciplinary hospital

Objectives. To evaluate the immediate results of surgical treatment of patients with large incisional hernia of the anterior abdominal wall with the use of the mesh implants.Materials and methods. The data were retrospectively collected and analyzed. The study included patients with a large and / or complex incisional hernia. There were 108 patients who underwent incisional hernia repair with mesh reinforcement in the period from 2012 to 2016. In all cases the repairs were made with mesh implants. The average age of patients was (56.4 ± 10.4) years. The body mass index (BMI) was on average (32.6 ± 6.24) kg/m2. The medial localization of the hernia was 102 (94.44%). The width of the hernia defect averaged (12.2 ± 3.7) cm. Implants were placement in onlay positions – 19 (17.6%), sublay – 49 (45.37%), IPOM (Intraperitoneal onlay mesh) – 30 (27.77%) patients, the component separation technique (CST) with mesh reinforcement was used in 10 (9.25%) patients. Active aspiration drainage was performed in 72 (66.66%) patients.Results. The average time for draining the postoperative wound was (5 ± 2.2) days. The number of wound complications was 23 (21.3%), the number of seromas of the postoperative wound prevailed was 16 (14.8%) patients, of which 2 (1.85%) were chronic abdominal wall seromas, hematoma occurred in 2 patients (1.85%), the number of prolonged serous exudation was 7 (6.5%), necrosis of the wound edges occurred in 4 (3.7%) patients. There was no mortality. Reliably more often wound complications occurred in patients with large hernia defects (p = 0.006), and also with an increase in the duration of surgical intervention (p = 0.01). The hospital-stay in patients with complications was significantly greater (p < 0.001), the need for analgesics also increased (p < 0.001).Conclusion. Prevention of wound complications after large and complex incisional hernia repair with mesh reinforcement is an important direction in improving the results of surgical treatment in this category of patients.

A new modified technique in hernia repair in patients with decompensated cirrhosis and complicated hernia: single center experience

Patients with decompensated cirrhosis have a high incidence of abdominal wall hernias To evaluate the outcome of a new technique in the repair of complicated hernias in decompensated cirrhotic patients. Thirty decompensated cirrhotic patients underwent herniorraphy for complicated hernia. Patients were in G I (New technique:15): and II (non-anatomical repair, 15). Patients were followed for one year. Comparable between G I and II regarding age (48.27± 9.51vs. 44.33±9.98, P=0.279), sex [12 males (80%) vs. 12males (80%), P=1], grade of ascites [moderate: 3 (20%) vs. 11 (73.3%) and marked: 12 (80%) vs. 4 (26.6%), P=0.003]. Wound dehiscence and leakage (ascitic fluid) were significantly lower in group I [0% vs. 5 (33.3%), P=< 0.005 and 0% vs. 8 (53.3%), P=0.003, respectively]. In concern to morbidity there is significant difference between GI and II (negative in GI 11(73.3%) vs. 5(33.3%) in GII (P=0.028). The grade of ascites was reduced in GI vs. II [marked: 0% vs. 7 (46.7%), P=0.003]. Postoperative hematemesis was lower in GI {negative in 15(100%) in G I vs. 7(46.7%) in GII and P=0.003)}, and hospital stay was shorter in GI vs. II (6.5±4.0 vs. 12.8±3.0, P< 0.0001). Hernia recurrence was lower in GI at 6 and 12 months [no recurrence in GI 13 (86.67%) vs. G II 5 (35.7%), P=0.014. and no recurrence in GI, 11 (73.33%) vs. G II 4 (28.57%), P=0.011 respectively]. The new technique of hernia repair was associated with a significant reduction in wound leakage, dehiscence, hospital stay, morbidity and recurrence.

Pedicled, innervated vastus lateralis (PIVL) flap for abdominal wall incisional hernia following kidney transplant and its proposed use in large lateralised incisional hernia - A new application for an established technique

Pedicled, innervated vastus lateralis (PIVL) flap for abdominal wall incisional hernia following kidney transplant and its proposed use in large lateralised incisional hernia - A new application for an established technique

A New Approach to an Old Technique—The S.U.T.R. First Technique

Ventral and incisional hernias of the abdominal wall are common problems treated by surgeons around the globe. Incisional hernias are common postoperative complications of abdominal laparotomies with a reported incidence of up to 20 per cent. The increasing use of prosthetic mesh in open ventral hernia repairs necessitated the development of different operative techniques used in the repairs. It also required that surgeons become facile with placement of the mesh in different anatomical positions on the abdominal wall. One of the most common locations is placement of the mesh in the underlay position. Many surgeons who use the underlay technique have expressed significant concerns. Among these are fear of an inadvertent bowel injury while placing the mesh, poor visualization during mesh placement, and the inability to use the underlay technique for difficult hernias. We present a very useful, if not, novel technique of open hernia repair using mesh in the underlay position that helps to 1) prevent complications, 2) facilitate easier mesh fixation, 3) simplify open repair of atypical ventral hernias, and 4) reduce total operative time while still adhering to the important fundamental principles of a tension-free hernia repair. This technique as we describe it has been compared with the old parachute technique, but we think this is a significant improvement of that seldom used technique. We believe the use of this technique for the underlay position makes open ventral hernia repair safer, faster, and easier; however, our goal for this article is to describe the procedure in detail. In addition, we recently have started using this technique to fix the mesh when doing the retrorectus approach as well.

The abdominal wall incisional hernia repair in cirrhotic patients.

The incidence of abdominal wall hernia in cirrhotic patients with ascites is between 20 and 40%. Controversies regarding the treatment modality and surgical timing of abdominal wall incisional hernia repair in cirrhotic patients remain. The study proposed wants to analyze the abdominal incisional hernia repair in cirrhotic patients with ascites performed in a single center to determine post-operative morbidity, mortality and complication rate. Cirrhotic patients with abdominal incisional hernia that underwent surgical operation for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital between January 2015 and December 2016 were identified and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and the surgical and ICU registries. The degree of hepatic dysfunction was classified using Child-Pugh classification. Post-operative mortality was considered up to 30-days after surgery. A follow-up period of 6 months at least was performed to evaluate hernia recurrence and complications. Mortality rate is of 18.5% (p 0.002). Recurrence rate (p 0.004) and seroma formation rate (p 0.001) are most frequent in urgency group. The elevated ASA score and the prediction of a complicated post-operative course is higher in urgency group (p 0.004) as higher is the in-hospital stay (p 0.001) and the ICU stay (p 0.001). Elective surgery for abdominal wall hernia repair in cirrhotic patients seems to be successful and associated with lower mortality/morbidity rate and recurrence rate than urgency.

Transversus abdominis muscle release: Technique, indication, and results

Component separation technique (CST) allows the mobilization of large musculofascial flaps of the abdominal wall and was developed for the treatment of very large, primary and incisional abdominal wall hernias. The classic open anterior CST first published by Albanese and later by Ramirez is associated with high complication rates. According to a recent literature review, CST without mesh should no longer be performed because of high recurrence rates. Classic anterior CST is associated with high rates of surgical-site occurrences and infections and should only be performed as endoscopic- and perforator-sparing anterior CST. The unfavorable results of classic CST resulted in the development of numerous new anterior and posterior CST modifications, several of them were minimally invasive. The posterior CST with transversus abdominis muscle (TAM) release (TAR) published by Novitsky et al. is an extension of the original retrorectus Rives operation and Stoppa procedure. The technique avoids vast skin flaps and allows the closure of large abdominal wall defects and insertion of very large retromuscular alloplastic standard sublay meshes without damaging the vessels and intercostal nerves. The TAR procedure is one of the major advances of abdominal wall surgery of the last decades. Several new promising minimally invasive modifications including robotic-assisted TAR have been published recently. The indications and technique of the TAM (TAR) procedure and its minimally invasive modifications are described.

A pregnant woman with a surgical site infection after mesh repair of an abdominal wall incisional hernia: a case report

BackgroundSurgical meshes are widely used in incisional hernia repair. However, there are no reports of pregnancies complicated by infection of surgical meshes used for hernia repair. This is the first case report of a pregnant woman who experienced surgical site infection associated with surgical mesh used for repair of an abdominal wall incisional hernia.Case presentationWe report a case of a 41-year-old pregnant Japanese woman with surgical site infection after mesh repair of an abdominal wall incisional hernia. She was diagnosed with an abdominal wall incisional hernia at 3 months after her third cesarean section, and she underwent an operation of hernia repair with use of monofilament polypropylene mesh 7 months after the third cesarean section. However, a surgical site infection associated with surgical mesh occurred. During antibiotic treatment, she was found to be pregnant. She was referred to our hospital at 13 weeks and 2 days of gestation. The surgeons removed the infected mesh at 16 weeks and 3 days of gestation. Neither the hernia nor infection at the surgical site recurred throughout pregnancy. We planned a cesarean section using a transverse uterine fundal incision method with an upper abdominal incision. The patient delivered a 2478-g healthy female infant.ConclusionsThe present report shows that removal of mesh can safely control surgical site infection during pregnancy.

Prospects of hernia and abdominal wall surgery in China

In recent 20 years, hernia and abdominal wall surgery has made great progress in China. However, what we've done still leaves much to be desired. Related guidelines of hernia disease had been conducted, but China is short of multi-center, prospective, and large-sample research evidence. These guidelines are still with low evidence level, and contents need additional modified to well meet Chinese real situation. In terms of treatment of inguinal and abdominal wall incisional hernia, some consensus has been reached from certain key issues globally, but further exploration are still needed. To stand at top of the world, we are a long distance. We should not only strengthen training and quality control but also establish patient registration system and overall management process.

Mesh vs. Suture Closure of Incisional Hernias

Patients often seek referrals from their primary care clinicians for repair of an abdominal wall incisional hernia and sometimes seek counsel about the