PurposeTo characterise international contemporary practice in dissection and closure of lower abdominal transverse incisions (LATI) across surgical specialties.MethodsAn open, cross-sectional survey of surgeons with experience of performing LATI independently was conducted using an anonymised online questionnaire disseminated via professional networks. Data were captured pertaining to respondent characteristics, operative techniques for dissection and closure of abdominal layers, and experience with incisional hernias related to these incisions.ResultsOverall, 231 respondents from 31 countries across 6 continents were included, following relevant exclusions. Respondents comprised general surgeons (68.4%), obstetricians and gynaecologists (O&G; 26.4%) and urologists (5.2%). O&G respondents performed a significantly higher annual LATI case volume, when compared to other specialists (>50 cases/year: 60.7% vs. 6.5%, p < 0.001). Peritoneal entry varied between O&G and other surgeons, with O&G more commonly using blunt peritoneal entry (62.3% vs. 7.6%, p < 0.001) and a transverse, rather than longitudinal, peritoneal opening (54.1% vs. 15.9%, p < 0.001). Rates of peritoneal non-closure were higher amongst O&G compared to other subspecialties (77.0% vs. 24.1%, p < 0.001). More frequent use of a ‘small bites’ fascial closure technique was noted among general surgeons and urologists (85.3%), when compared to O&G (42.6%, p < 0.001). Most respondents considered LATI hernias to be underreported (84.0%), however more general surgeons had encountered LATI hernias (general surgery: 85.4%, urology: 41.7% and O&G: 42.6%, p < 0.001).ConclusionThere is substantial inter-specialty variation in closure techniques for LATI. Differences in practice may influence incisional hernia development and reporting, highlighting a need for further outcome-focused research and standardisation.
BackgroundTension-reduced midline closure remains a key challenge in the minimally invasive repair of large and complex ventral and incisional hernias. Commonly employed adjuncts, such as botulinum toxin A (BTA), progressive pneumoperitoneum (PPP), and component separation (CS), increase treatment complexity and may be associated with additional morbidity. Intraoperative fascial traction (IFT) has been described in open surgery to facilitate fascial medialisation; however, data related to its application in minimally invasive and robotic approaches supplementing IFT are scarce.MethodsA retrospective analysis was conducted of six patients who underwent robotic-assisted enhanced-view totally extraperitoneal (eTEP) ventral hernia repair with adjunctive IFT between June 2024 and March 2025. A comprehensive preoperative workup was performed, which included clinical evaluation and computed tomography (CT) imaging. The width of the fascial defect was meticulously measured intraoperatively before and after traction. For patients with transverse defects exceeding 15 cm, preoperative BTA injections were administered.ResultsThe mean pre-traction defect width was 15.8 ± 5.4 cm and reduced to 8.9 ± 3.2 cm following traction, achieving a mean medialisation of 6.9 ± 1.8 cm. Tension-reduced midline closure was achieved in all patients, without the need for CS or conversion to open surgery. Postoperative recovery was uneventful, with low pain scores, early ambulation, and no surgical site complications or 30-day readmissions.ConclusionIFT is a feasible and effective adjunct in robotic eTEP repair of large ventral hernias. When combined with robotic precision, it facilitates closure without undue fascial tension while preserving abdominal wall integrity and avoiding CS. Larger-scale studies are warranted to validate these findings.
BackgroundMillions of people undergo surgery with utilises a lower abdominal transverse incision (LATI). These incisions offer straightforward surgical access to the abdomen and pelvis and are ubiquitously used worldwide including for caesarean section. The incidence of hernia following these incisions have not been comprehensively studied and there are marked differences in abdominal entry across different LATI types. To address these hernias with a pivotal role in recognition and awareness, we propose a new term for hernias arising from these incisions: Lower Abdominal Transverse Interparietal/Incisional Hernias (LATI-H).MethodsA narrative review based on relevant literature was conducted to explore how LATI-H is described and reported. We searched the literature using MEDLINE and PubMed from inception to March 2025 to identify relevant studies. We retrieved relevant articles and included articles which described lower abdominal transverse incision complications including their hernias, with no limit on indication. Non-English articles were translated by medical translator for accurate understanding of the technique and literal transcription.ResultsLower abdominal transverse incisional hernias are poorly described and defined in the literature. They are frequently incorporated to large series of incisional hernias, but they are usually a mix of a large posterior defect with small incisional defects and have different features from other types of incisional hernia. This makes lower abdominal transverse interparietal hernias (LATI-H) a concern for general surgeons due to difficult diagnosis. LATI-H can progress and risk serious complications such as bowel obstruction and bowel ischemia.ConclusionLower abdominal transverse interparietal hernias (LATI-H) are poorly defined and are often erroneously termed Pfannenstiel or C-section hernias. The authors suggest the use of LATI-H to provide clear definition and provide a framework for future research to identify how these arise and find strategies to prevent and repair these hernias effectively.
PurposeTo evaluate quality of life (QoL), abdominal wall pain and discomfort 1 and 3 years after colorectal cancer (CRC) surgery in patients with and without incisional hernia (IH) and perform a risk factor analysis for impaired QoL.MethodsLongitudinal observational study with patients included in the randomized controlled trial, Rein4CeTo1, carried out 2017–2021. Patients underwent CT-scans 12 ± 3 and 36 ± 3 months after surgery, scrutinized for diagnosis of IH. General health was evaluated using the EQ-5D-5L questionnaire. For QoL related to IH and overall abdominal wall symptoms a slightly modified version of the Ventral Hernia Pain Questionnaire (VHPQ) was used. Potential risk factors of impaired QoL were investigated with multivariable linear regression analysis.ResultsOf 160 randomized patients, 134 were eligible for 1-year follow-up and 119/134 (89%) answered the questionnaires. Corresponding numbers at 3 years was 81/101 (80%). The EQ-5D-5L results were similar at 1 and 3 years for patients with and without IH (p = 0.276 1 year, p = 0.404 3 years). The VHPQ concluded low frequency of pain, stiffness in the abdominal wall and other discomforting symptoms without differences between patients with and without IH. In multivariable linear regression stoma was an independent risk factor for impaired general QoL at 3 years, p < 0.005.ConclusionIn this study, comparing QoL 1 and 3 years after CRC surgery, we could not find a statistically significant difference in patients developing an IH compared to those who did not. The presence of a stoma was an independent risk factor for impaired general QoL after 3 years.
