[Differentiated concept for treatment of incisional hernias]

With an incidence of up to 20%, incisional hernias represent a frequent late complication following abdominal surgery. The diagnosis is primarily made clinically and supported by ultrasound, particularly with smaller defects; however, large or complex hernias should be further evaluated using cross-sectional imaging, preferably with computed tomography (CT). Magnetic resonance imaging (MRI) can be considered a suitable alternative when ionizing radiation is contraindicated. The European Hernia Society (EHS) has developed a classification system to standardize the assessment of hernia location and size, thereby improving comparability between studies and enhancing communication in clinical practice. Considering the low overall risk of incarceration, surgical treatment is typically indicated based on clinical symptoms. Current evidence indicates significantly lower recurrence and complication rates associated with retromuscular mesh hernia repair. It is therefore considered to be the gold standard and is increasingly being performed using minimally invasive and robot-assisted approaches.