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Table of Contents
EDITORIAL
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 1

Expanding your surgical tools for large ventral and incisonal hernias


Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium

Date of Submission11-Jan-2022
Date of Acceptance12-Jan-2022
Date of Web Publication23-Feb-2022

Correspondence Address:
Prof. Dr. Frederik Berrevoet
Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent.
Belgium
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijawhs.ijawhs_4_22

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How to cite this article:
Berrevoet F. Expanding your surgical tools for large ventral and incisonal hernias. Int J Abdom Wall Hernia Surg 2022;5:1

How to cite this URL:
Berrevoet F. Expanding your surgical tools for large ventral and incisonal hernias. Int J Abdom Wall Hernia Surg [serial online] 2022 [cited 2022 May 18];5:1. Available from: http://www.herniasurgeryjournal.org/text.asp?2022/5/1/1/338069



The evolution in surgical techniques for abdominal wall reconstruction is moving faster than in almost any other field of surgery. Equipment and instruments, but also anatomical knowledge, drive surgeons always further in their capacity to help patients with significant abdominal wall defects.

In this issue, several outstanding and internationally renowned hernia specialists discuss in detail the current toolbox that surgeons might need to master before tackling these huge defects and their associated pre-, intra-, and postoperative issues. Defects over 10–12 cm probably need a separation of the abdominal wall components, but which one to choose? Initially, every surgeon was convinced that an anterior release of the external oblique aponeurosis was the key, but since 2012, with the introduction of a transversus abdominis release technique, the number of indications for the Ramirez technique dropped significantly mainly due to the high postoperative wound morbidity. Or is an endoscopic or perforator sparing technique a good solution to decrease wound complications? Maybe, in some indications, component separation might even be prevented completely by the use of botulinum toxin A. There remain many unknown elements for us as surgeons in using botox, but it seems to work with little, if any, disadvantages for the patient!

In contrast, loss of domain will add to the complexity and an adequate preoperative optimization is essential. Postoperative care, especially in patients with comorbidities, will be demanding in these highly complex situations.

There is of course a drawback to all these innovations and the expanding spectrum of tools and techniques: the case volume might be too low for each surgeon, or even each center, to justify their general application. In contrast, there is no “rocket science” necessary to learn these techniques, but an acceptable case load is essential. It seems indeed inevitable that complex cases should be centralized to achieve patients’ best outcomes and abdominal wall reconstruction as a sub-specialism is not far away in that perspective!

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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