[Management of lateral abdominal wall hernias]

Area of Science:

• Abdominal wall surgery
• Hernia repair
• Surgical classification

Background:

• Lateral abdominal wall hernias are rare and inconsistently defined.
• Distinguishing true fascial defects from denervation atrophy is crucial.
• Existing literature shows low evidence levels and no consensus on the optimal surgical approach.

Purpose of the Study:

• To advocate for the European Hernia Society classification for lateral hernias.
• To compare surgical results and establish best practices.
• To address the challenges in treating lateral hernias due to complex anatomy.

Main Methods:

• Review of available literature on surgical strategies for lateral hernias.
• Discussion of various surgical approaches including laparoendoscopic, robotic, minimally invasive, open, and hybrid techniques.
• Analysis of mesh placement in relation to abdominal wall layers.

Main Results:

• Extensive preperitoneal mesh reinforcement, transabdominal peritoneal (TAPP) laparoscopic repair, and total extraperitoneal (TEP) endoscopic repair are favored.
• Medial mesh overlap extent depends on defect boundary and rectus abdominis muscle proximity.
• Intraperitoneal onlay mesh (IPOM) is suitable for smaller defects or peritoneal defects.

Conclusions:

• Standardized classification (European Hernia Society) is recommended for comparing surgical outcomes.
• Preoperative assessment, including imaging, and individualized prehabilitation are vital.
• Complex anatomy necessitates careful surgical planning and technique selection for lateral hernia repair.