The prehabilitation of the abdominal wall through the infiltration of botulinum toxin type A, which induces temporary chemical denervation (\"chemical component separation\") in the lateral abdominal musculature, is a common practice in units specialized in abdominal wall surgery. However, its use for this indication is currently off-label. The main objective of this article is to describe a consensus proposal regarding indications, contraindications, dosages employed, potential side effects, administration method, and measurement of possible outcomes. Additionally, a proposal for an informed consent document endorsed by the Abdominal Wall Section of the Spanish Association of Surgeons is attached.

BACKGROUND: From an epidemiological point of view, one third of the population in industrialized countries will undergo abdominal surgery during their lifetime. Depending on the degree of patient-related and procedure-related risks, the occurrence of incisional hernias is associated in a range of up to 30% at 2‑year follow-up and even up to 60% at 5 years. In addition to influencing comorbidities, the type of surgical approach and closure technique are of critical importance.
OBJECTIVE: To present a descriptive evidence-based recommendation for abdominal wall closure and prophylactic mesh augmentation.
METHODS: A concise summary was prepared incorporating the current literature and existing guidelines.
RESULTS: According to recent studies the recognized risk for the occurrence of incisional hernias in the presence of obesity and abdominal aortic diseases also applies to patients undergoing colorectal surgery and the presence of diastasis recti abdominis. Based on high-level published data, the short stitch technique for midline laparotomy in the elective setting has a high level of evidence to be a standard procedure. Patients with an increased risk profile should receive prophylactic mesh reinforcement, either onlay or sublay, in addition to the short stitch technique. In emergency laparotomy, the individual risk of infection with respect to the closure technique used must be included.
CONCLUSIONS: The avoidance of incisional hernias is primarily achieved by the minimally invasive access for laparoscopy. For closure of the most commonly used midline approach, the short stitch technique and, in the case of existing risk factors, additionally mesh augmentation are recommended.
UNASSIGNED: HINTERGRUND: Aus epidemiologischer Sicht erfolgt bei einem Drittel der Bevölkerung in den Industrieländern im Laufe des Lebens eine abdominelle Operation. Je nach Grad des patientInnen- wie auch eingriffsbezogenen Risikos ist das Auftreten von Narbenhernien in einem Bereich von bis zu 30 % im 2‑Jahres-Follow-up und sogar bis zu 60 % nach 5 Jahren verbunden. Neben den beeinflussenden Komorbiditäten ist die Art des chirurgischen Zuganges und die Verschlusstechnik von entscheidender Bedeutung. ZIEL: Die deskriptive Darstellung einer evidenzbasierten Empfehlung zum Verschluss der Bauchdecke sowie einer prophylaktischen Netzaugmentation.
METHODS: Unter Einbeziehung der aktuellen Literatur und der bestehenden Leitlinien wurde eine übersichtliche Zusammenfassung erstellt.
UNASSIGNED: Das bekannte Risiko für das Auftreten von Narbenhernien gilt bei Vorliegen von Adipositas und Erkrankungen der Bauchaorta nach neuesten Studien auch für PatientInnen mit einem kolorektalen Eingriff und Vorliegen einer Rektusdiastase. Auf Basis hochrangig publizierter Daten ist die Kurzstichtechnik bei Laparotomien der Mittellinie im elektiven Setting mit hoher Evidenz als Standardverfahren zu bezeichnen. PatientInnen mit erhöhtem Risikoprofil sollten neben der Kurzstichtechnik eine prophylaktische Netzverstärkung, sei es in Onlay- oder Sublay-Technik, erhalten. Bei Notfalllaparotomien muss das individuelle Infektionsrisiko bezüglich der angewendeten Verschlusstechnik einbezogen werden.
UNASSIGNED: Die Vermeidung von Narbenhernien ist in erster Linie durch den minimal-invasiven Zugang der Laparoskopie zu erzielen. Zum Verschluss des am häufigsten angewendeten Mittellinienzuganges ist die Kurzstichtechnik und bei bestehenden Risikofaktoren zusätzlich eine Netzaugmentation zu empfehlen.

暂无摘要。

暂无摘要。

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline\'s recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline\'s strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).

暂无摘要。

暂无摘要。

Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia.
A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative.
Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised.
These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.
An incisional hernia results from a weakness of the abdominal wall muscles that allows fat from the inside or organs to bulge out. These hernias are quite common after abdominal surgery at the site of a previous incision. There is research that discusses different ways to close an incision and this may relate to the chance of hernia formation. The aim of this study was to review the latest research and to provide a guide for surgeons on how best to close incisions to decrease hernia rates. When possible, surgery through small incisions may decrease the risk of hernia formation. If small incisions are used, it may be better if they are placed away from areas that are already weak (such as the belly button). If the incision is larger than 1 cm, it should be closed with a deep muscle-fascia suture in addition to skin sutures. If there is a large incision in the middle of the abdomen, the muscle should be sutured using small stitches that are close together and a slowly absorbable suture should be used. For patients who are at higher risk of developing hernias, when closing the incision, the muscle layer can be strengthened by using a piece of (synthetic) mesh. There is no good research available on recovery after surgery and no clear guides on activity level or whether a binder will help prevent hernia formation.

Although obtaining preoperative procedural consent is required to meet legal and ethical obligations, consent is often relegated to a unidirectional conversation between surgeons and patients. In contrast, shared decision-making (SDM) is a collaborative dialog that elicits patient preferences. Despite emerging interest in SDM, there is a paucity of literature on its application to ventral incisional hernia repair (VIHR). The various surgical techniques and mesh types available, the potential impact on functional outcomes and quality of life, the largely elective nature of the operation, and the significant risk of perioperative patient complications render VIHR an ideal field for SDM implementation.
The authors reviewed the current literature and drew on their own practice experience to describe evidence-based practical guidelines for implementing the SDM into VIHR care.
We summarized the evidence basis for SDM in surgery and discussed how this model can be applied to VIHR given the multiple, complex factors that influence surgical decision-making. We outlined an example of using an SDM framework, \"SHARE,\" with a patient with a large, recurrent ventral hernia.
SDM has the potential to improve patient-centered and preference-concordant care among individuals being considered for VIHR to ensure that treatment interventions meet a patient\'s goals, rather than solely treating the underlying disease process.