Journal of abdominal wall surgery : JAWS最新文献

{"title":"A European algorithm and strategy for management of chronic postoperative inguinal pain (EurA-CPIP).","authors":"K G Andersen, T W K van der Meer, N van Veenendaal, N B Foss, M J A Loos, M Miserez, M Pawlak, R M H Roumen, T Naddaf, M Togsverd-Bo, M W Stadeager, E K Aasvang, W A R Zwaans","doi":"10.3389/jaws.2026.16944","DOIUrl":"https://doi.org/10.3389/jaws.2026.16944","url":null,"abstract":"<p><strong>Background: </strong>Chronic postoperative inguinal pain (CPIP) is a disabling complication affecting 8%-17% of all patients after inguinal hernia repair. It is a complex pain condition with several pathophysiological mechanisms involved, including neuropathic pain, inflammation, and mechanical effects (e.g., mesh or scar tissue). Management remains inconsistent, probably due to limited high-quality evidence, heterogeneous approach, and insufficient standardisation of outcomes. This study aimed to develop EurA-CPIP, a multidisciplinary treatment algorithm and prospective data-collection platform designed to support consistent phenotyping, step-up management, and standardised outcomes across centres, creating an iterative platform for future hypothesis-driven research and multicentre trials.</p><p><strong>Methods: </strong>An international multidisciplinary working group from European tertiary referral centres developed the European Algorithm and Strategy for Management of Chronic Postoperative Inguinal Pain (EurA-CPIP). Development was informed by the evidence synthesis underpinning the updated international HerniaSurge guidelines and a critical appraisal of previously published CPIP algorithms. A pragmatic step-up algorithm was designed, integrating pharmacological, interventional, surgical and supportive treatments, with prospective outcome registration and planned data-driven revision on a regular basis.</p><p><strong>Results: </strong>EurA-CPIP provides a multidisciplinary algorithm with entry at multiple levels depending on prior treatment attempts. The concept is to begin and, if needed, advance from conservative measures such as systemic medication and topical therapy, to more invasive treatments such as trigger point injections, and ultrasound-guided nerve blocks; predefined investigational add-ons (radiofrequency, cryoneurolysis, botulinum toxin A) are embedded after documented block response. Multidisciplinary team review precedes escalation to more invasive interventions such as surgery. A supportive and rehabilitative coping trajectory is integrated early on. Standardised outcomes include patient-reported pain outcomes, functional impairment, psychological factors, analgesic use, and patient global impression of improvement.</p><p><strong>Conclusion: </strong>EurA-CPIP is a pragmatic consensus-based strategy intended to harmonise and improve specialised CPIP care while utilising existing and developing emerging therapies. Future research should investigate pathophysiology and intervention effects within this step-up algorithm.</p>","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"16944"},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13713437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149303625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior rectus sheath reattachment after eTEP rives: are we solving the right problem?","authors":"Jorge Daes","doi":"10.3389/jaws.2026.17986","DOIUrl":"https://doi.org/10.3389/jaws.2026.17986","url":null,"abstract":"","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17986"},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13711373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiologic recurrence after minimally invasive ventral hernia repair in patients with class III obesity: a single-center retrospective cohort study.","authors":"Ahsan Ahmed, Faizan Khalid, Ali Sadeghi, Marlon Rodriguez Valladares, Marlen Flores, Valeria Loja Pauta, Cesar Alas-Pineda, Cosman Camilo Mandujano","doi":"10.3389/jaws.2026.17051","DOIUrl":"10.3389/jaws.2026.17051","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a known risk factor for complications and recurrence after ventral hernia repair (VHR). Many surgeons defer elective repair in patients with class III obesity based on body mass index (BMI) thresholds. We evaluated postoperative outcomes and factors associated with recurrence after minimally invasive VHR in this high-risk population.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included consecutive adult patients with BMI ≥40 kg/m² who underwent predominantly minimally invasive VHR between January 1, 2012, and December 31, 2024, and had postoperative radiologic follow-up by computed tomography (CT). The primary outcome was radiologic hernia recurrence. Secondary outcomes included 30-day complications and postoperative weight trajectory. Between-group comparisons used Fisher's exact or χ² tests for categorical variables and Welch t-test or Mann-Whitney U test for continuous variables, as appropriate; two-sided p < 0.05 was considered significant.</p><p><strong>Results: </strong>Fifty-two patients (mean BMI 45.0 ± 5.4 kg/m²), 80.8% female, met the inclusion criteria. Radiologic recurrence occurred in 9 patients (17.3%; CI 9.4%-29.7%) at a median imaging follow-up of 793 days (IQR 412-1381) in the overall cohort. Recurrence was observed exclusively in incisional (2/16, 12.5%) or recurrent incisional hernias (7/21, 33.3%) (p = 0.028), with no recurrences in primary hernias (0/15). 30-day complications occurred in 11.5% of patients. Patients with recurrence experienced significantly greater postoperative weight loss than those without (15.6% vs. 4.6% of total body weight; p = 0.015). Operative technique and mesh-related variables were not significantly associated with recurrence (all p > 0.25), although the study was underpowered to detect such associations.</p><p><strong>Conclusion: </strong>Minimally invasive VHR in patients with class III obesity was associated with low short-term morbidity, but the mid-term radiologic recurrence rate of 17.3% is on the higher end of published estimates and should not be characterized as low. Recurrence occurred exclusively in incisional and recurrent incisional hernias, reaching 24.3% when primary hernias were excluded; associations with technical factors and BMI were not statistically significant in this small sample. Greater postoperative weight loss was associated with recurrence, though reverse causation and ascertainment bias cannot be excluded. Given the small sample size, these findings are hypothesis-generating and warrant confirmation in larger, prospective studies.</p>","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17051"},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inguinoscrotal hernia repair: analysis of the national EVEREG registry.","authors":"M Verdaguer-Tremolosa, V Rodrigues-Gonçalves, M P Martínez-López, M López-Cano","doi":"10.3389/jaws.2026.17525","DOIUrl":"https://doi.org/10.3389/jaws.2026.17525","url":null,"abstract":"<p><strong>Purpose: </strong>Inguinoscrotal hernia repair has been associated with worse outcomes compared to conventional repairs. Its optimal technique and prognostic factors remain unclear. We aimed to evaluate factors related to complications and recurrence in these repairs based on the EVEREG registry.</p><p><strong>Methods: </strong>Adult males who underwent elective unilateral inguinoscrotal hernia repair from 2021 to 2024 from the EVEREG registry were included. The primary outcome was postoperative complications. The secondary outcomes were to describe recurrence within 30 days and at latest available follow-up.</p><p><strong>Results: </strong>A total of 748 patients were included. Most patients (83.4%) underwent open repair, and the preferred mesh position was anterior in 70.8% of cases. Postoperative complications occurred in 6.95% of cases, mostly grade I-II of the Clavien-Dindo classification. Advanced age, diabetes, chronic obstructive pulmonary disease, higher ASA grade, H4-type hernia, open surgical approach, intraoperative complications, and longer operative times were identified as factors associated with postoperative complications (P < 0.001, P = 0.018, P = 0.035, P < 0.001, P = 0.007, P = 0.002, P = 0.039, and P < 0.001). Ambulatory surgery and the involvement of a surgeon with experience in abdominal wall repair were associated with better outcomes (P < 0.001, P = 0.029). Multivariate analysis yielded consistent results regarding protective factors. At maximum follow-up, the presence of a surgeon experienced in abdominal wall repair was the only factor linked to lower recurrence risk.</p><p><strong>Conclusion: </strong>According to the EVEREG registry, the most common approach for inguinoscrotal hernia repair was open surgery with anterior mesh placement. Postoperative complications occurred mainly in patients with greater comorbidity and hernia complexity and were mostly low-grade. Surgery performed by a surgeon experienced in abdominal wall surgery was associated with fewer postoperative complications, supporting individualised management and consideration of referral for complex cases. The available data do not allow conclusions regarding the superiority of a specific technique or long-term recurrence.</p>","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17525"},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149241112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incisional hernia prevention in high-risk midline laparotomy using onlay PVDF mesh: multicenter prospective observational study.","authors":"Jose Luis Rodicio Miravalles, Javier López Monclús, Sonia Amoza Pais, María Moreno Gijón, Antonio López López, Natalia Gutiérrez Corral, Luis Alberto Blázquez Hernando, Rafael Menéndez de Llano Ortega, María Isabel Diez Pérez de Las Vacas, Lourdes Sanz Álvarez, Miguel Angel Garcia-Urena","doi":"10.3389/jaws.2026.17201","DOIUrl":"10.3389/jaws.2026.17201","url":null,"abstract":"<p><strong>Introduction: </strong>Prophylactic mesh reinforcement reduces the risk of incisional hernia after midline laparotomy in high-risk patients, although concerns regarding complications and implementation limit its routine use. This multicentre prospective observational study evaluated long-term outcomes after onlay polyvinylidene fluoride (PVDF) mesh reinforcement in high-risk patients undergoing midline laparotomy in elective and emergency settings.</p><p><strong>Materials and methods: </strong>A prospective multicentre observational cohort study was conducted in tertiary and secondary hospitals within the Spanish National Health Service between July 2016 and June 2022. Adult patients undergoing midline laparotomy with more than one risk factor for incisional hernia were included. Abdominal wall closure was reinforced with an onlay PVDF mesh visible on MRI. The primary outcome was incisional hernia at 2 years. Secondary outcomes included mesh-related complications and factors associated with incisional hernia.</p><p><strong>Results: </strong>A total of 180 patients were analysed. Mean age was 64.6 years and mean BMI was 27.4 kg/m². Most procedures were performed for oncological disease (72.8%), 32.8% were emergency operations, and 23.9% were performed in contaminated or dirty surgical fields. Surgical-site infection occurred in 12.8% and seroma in 9.4% during index admission. Mesh removal was required in four patients (2.2%). Two-year follow-up among surviving patients reached 96.1%. In the intention-to-treat analysis, incisional hernia developed in 21 patients (11.3%), compared with 16 patients (8.9%) in the per-protocol analysis. BMI (OR 1.19, 95% c.i. 1.05 to 1.33; P = 0.008) and stoma formation (OR 5.77, 95% c.i. 1.75 to 19.30; P = 0.004) were independently associated with incisional hernia. MRI demonstrated no significant mesh contraction.</p><p><strong>Conclusion: </strong>In this prospective multicentre observational study, prophylactic onlay PVDF mesh reinforcement in high-risk midline laparotomy, including emergency and contaminated procedures, was feasible and associated with a low incidence of incisional hernia and acceptable mesh-related morbidity. These findings are hypothesis-generating and warrant further evaluation in controlled studies.</p>","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17201"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective use of reinforced tissue matrix in complex abdominal wall reconstruction: a multicenter consensus analysis.","authors":"Sebastian Schaaf, Thomas Mones, Peter Mai, Niels-Torsten Hoedt, Markus Götz, Arnulf Willms, Guido Woeste","doi":"10.3389/jaws.2026.17323","DOIUrl":"10.3389/jaws.2026.17323","url":null,"abstract":"<p><strong>Background: </strong>Optimal mesh selection in complex abdominal wall reconstruction remains controversial, particularly in contaminated fields or in patients with extensive tissue loss. Reinforced tissue matrix (RTM) meshes combine biologic material with permanent synthetic reinforcement and may represent a potential option in selected cases. This study aimed to analyze clinical use patterns of RTM meshes and identify potential indication niches through structured expert consensus.</p><p><strong>Methods: </strong>A multicenter expert panel collected cases of abdominal wall reconstruction using RTM mesh (OviTex). Patient characteristics, hernia features, operative strategies, and postoperative outcomes were recorded in a standardized database. Cases were evaluated according to established complexity criteria. Seven abdominal wall surgeons independently rated the appropriateness of RTM use. Consensus was defined as ≥70% agreement, and interrater reliability was assessed using Fleiss' kappa.</p><p><strong>Results: </strong>Seventy-four patients were included (mean age 63.9 ± 12.0 years; median BMI 30.2 kg/m²). Most patients presented with incisional hernias and large fascial defects. Contaminated or potentially contaminated operative fields were present in approximately one-third of cases. Surgical site infection occurred in 20.3%, mesh infection in 7.8%, and hernia recurrence in 12.3%. Expert consensus supporting RTM implantation was reached in 50% of cases, particularly in scenarios combining contamination with large fascial defects. Interrater agreement was fair (κ = 0.34).</p><p><strong>Conclusion: </strong>Routine use of RTM meshes in abdominal wall reconstruction is not supported. However, RTM may represent a potential option in selected high-complexity scenarios involving contamination and large fascial defects where permanent synthetic meshes may be unsuitable. These findings are exploratory and hypothesis-generating and may support future Delphi-based indication consensus development.</p>","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17323"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large registries, rare outcomes and neutral/inconclusive machine learning results in abdominal wall surgery.","authors":"M Verdaguer-Tremolosa, Sergi Mojal, V Rodrigues-Gonçalves, M P Martínez-López, M López-Cano","doi":"10.3389/jaws.2026.17526","DOIUrl":"https://doi.org/10.3389/jaws.2026.17526","url":null,"abstract":"","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17526"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ORION study protocol: impact of prior intraperitoneal versus extraperitoneal mesh placement on subsequent minimally invasive abdominal reoperations.","authors":"Elisa Pelfini, Sara Lauricella, Antonella Nisi, Gianlorenzo Dionigi, Francesco Brucchi","doi":"10.3389/jaws.2026.17325","DOIUrl":"https://doi.org/10.3389/jaws.2026.17325","url":null,"abstract":"<p><strong>Background: </strong>Ventral 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.</p><p><strong>Objective: </strong>This study addresses that gap, also examining the management of recurrences and the potential neurological sequelae of surgery.</p><p><strong>Methods: </strong>The 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.</p><p><strong>Discussion: </strong>The 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.</p><p><strong>Clinical trial registration: </strong>Identifier NCT07384962.</p>","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17325"},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of an AI workshop on knowledge and attitudes toward AI in scientific publishing among surgeons at an international abdominal wall surgery congress.","authors":"Mireia Verdaguer-Tremolosa, Georgia Kotoreni, Simon Hoggart, Manuel López-Cano","doi":"10.3389/jaws.2026.17401","DOIUrl":"10.3389/jaws.2026.17401","url":null,"abstract":"<p><strong>Background: </strong>Generative artificial intelligence (AI) tools are increasingly used for scientific writing, literature synthesis, and peer-review, yet their responsible use requires awareness of hallucinations, fabricated references, confidentiality risks, authorship limitations, and disclosure requirements.</p><p><strong>Objective: </strong>To evaluate the perceived impact of a focused educational workshop on knowledge and attitudes toward AI in scientific publishing among participants in an abdominal wall surgery workshop.</p><p><strong>Methods: </strong>An anonymous pre-post survey study was conducted during the JAWS Workshop 2026 on Artificial Intelligence in abdominal wall surgery. Participants voluntarily completed a 10-item baseline survey before two educational presentations and a 10-item post-workshop survey immediately afterwards. Responses were analysed descriptively. Because the questionnaires were not identical, formal paired analysis was restricted to the common ordinal knowledge item using anonymous participant codes.</p><p><strong>Results: </strong>Thirty-nine participants completed the baseline survey and 41 completed the post-workshop survey; 34 anonymous codes could be matched. Before the workshop, 48.7% reported basic knowledge, 35.9% intermediate knowledge, 5.1% advanced knowledge, and 10.3% no knowledge. AI tools were used occasionally, frequently, or systematically by 89.7% of respondents. The most frequent uses were language editing (74.4%), manuscript structuring (46.2%), literature summarization (46.2%), and data analysis or interpretation (41%). After the workshop, intermediate or advanced self-reported knowledge was observed in 68.3% of respondents. In matched analysis, self-reported knowledge scores improved in 18/34 participants (52.9%; Wilcoxon signed-rank, p = 0.0005). Post-workshop, 92.7% agreed or strongly agreed that they better understood AI limitations, 97.6% would almost always or always verify AI-generated references, 85.4% supported disclosure of AI use in manuscripts, and 87.8% considered society guidelines recommended or essential.</p><p><strong>Conclusion: </strong>AI use for scientific activities was common among workshop participants, and a brief targeted educational intervention was associated with improved self-reported knowledge and support for responsible AI use. Scientific societies and journals may play an important role in promoting the responsible integration of AI into scientific publishing through focused educational initiatives.</p>","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17401"},"PeriodicalIF":0.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary global practice in dissection and closure techniques for lower abdominal transverse incisions: a cross-sectional survey.","authors":"Leo R Brown, Hephzibah Adegoke, Ellen Gardner, Thomas M Drake, James Lucocq, Artur Zanellato","doi":"10.3389/jaws.2026.17006","DOIUrl":"10.3389/jaws.2026.17006","url":null,"abstract":"<p><strong>Purpose: </strong>To characterise international contemporary practice in dissection and closure of lower abdominal transverse incisions (LATI) across surgical specialties.</p><p><strong>Methods: </strong>An 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.</p><p><strong>Results: </strong>Overall, 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%, <i>p</i> < 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%, <i>p</i> < 0.001) and a transverse, rather than longitudinal, peritoneal opening (54.1% vs. 15.9%, <i>p</i> < 0.001). Rates of peritoneal non-closure were higher amongst O&G compared to other subspecialties (77.0% vs. 24.1%, <i>p</i> < 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%, <i>p</i> < 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%, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>There 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.</p>","PeriodicalId":516856,"journal":{"name":"Journal of abdominal wall surgery : JAWS","volume":"5 ","pages":"17006"},"PeriodicalIF":0.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}