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Background: The aim of this study was to assess the utility of the EVEREG registry in evaluating the evolution of surgical treatment for incisional hernia and its outcomes in Spain by comparing data from 2 study periods., Methods: A retrospective comparative analysis of hernia surgeries performed between 2011 and 2015 (first period) and between 2017 and 2022 (second period) was conducted using data collected from the EVEREG registry., Results: Statistically significant differences were observed in the second cohort, including: a decrease in minimally invasive procedures (11.7% vs 8.2%; P < .001), an increase in emergency surgeries for males (31.7% vs 41.2%; P = .017), an increase in trocar hernia repairs (16% vs 26.2%; P < .0001), a reduction in suture repairs (2.8% vs 1.5%; P < .0001), and an increase in retromuscular techniques (36.4% vs 52.4%; P < .001) in open surgery with mesh. In elective surgery, there was a decrease in the average length of stay (4.9 vs 3.8 days; P < .0001), the percentage of complications (27.9% vs 24.0%; P < .0001), reoperations (3.5% vs 1.4%; P < .0001), and mortality (0.6% vs 0.2%; P = .002). Long-term outcomes included a decrease in recurrences after 12 months (20.7% vs 14.5%; P < .0001) and in chronic pain (13.7% vs 2.5%; P < .0001) and chronic infections (9.1% vs 14.5%; P < .0001) after 6 months., Conclusion: In recent years, there has been a significant improvement in the outcomes of incisional hernia treatment. The registry serves as a fundamental tool for assessing the evolution of hernia treatment and enables the identification of key areas for improvement and the evaluation of treatment outcomes., (Copyright © 2024. Published by Elsevier España, S.L.U.)

The Spanish Association of Surgeons (AEC) deems it essential to define and regulate the acquisition of high-specialization competencies within General Surgery and Gastrointestinal Surgery and proposes the Regulation for the accreditation of specialized surgical units. The AEC aims to define specialized surgical units as those functional elements of the health system that meet the defined requirements regarding their provision, solvency, and specialization in care, teaching, and research. In this paper we present the proposed accreditation model for Abdominal Wall Surgery Units, as well as the results of a survey conducted to assess the status of such units in our country. The model presented represents one of the pioneering initiatives worldwide concerning the accreditation of Abdominal Wall Surgery Units., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Laparoscopic inguinal hernia repairs are underused in our country and do not fulfil to the recommendations of the European Hernia Society (EHS) guidelines. Thus, it is essential to establish measures that increase its use. We propose that the Spanish Association of Surgeons (AEC) promote these actions and that they should be incorporated into the specialty program. The proposed measures include Standardization of learning; reinforce anatomical knowledge; regulated practices with simulators; promote the use of the open posterior approach; rotations through centers of excellence; accreditation of specialized units and use a registry of activity as quality control., (Copyright © 2023 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Incisional hernia (IH) is a very common surgical procedure. Registries provide real world data. The objective is to analyze the open and minimally invasive (MIS) sublay technique (with or without associated components separation [CS]) in IH cases from the EVEREG registry and to evaluate the evolution over time of the techniques., Methods: All patients in EVEREG from July 2012 to December 2021 were included. The characteristics of the patients, IH, surgical technique, complications and mortality in the first 30 days were collected. We analyzed Group 1 (open sublay vs MIS sublay, without CS), Group 2 (open sublay vs MIS sublay, with CS) and Group 3 where the evolution of open and MIS techniques was evaluated over time., Results: 4867 IH were repaired using a sublay technique. Group 1: 3739 (77%) open surgery, mostly midline hernias combined (P = .016) and 55 (1%) MIS, mostly lateral hernias (LH) (P = .000). Group 2: 1049 (21.5%) open surgery and 24 (0.5%) MIS. A meaningful difference (P = .006) was observed in terms of transverse diameters (5.9 (SD 2.1) cm for the MIS technique and 10.11 (SD 4.8) for the open technique). The LH MIS associated more CS (P = .002). There was an increase in the use of the sublay technique over time (with or without CS)., Conclusion: Increased use of the sublay technique (open and MIS) over time. For some type of hernia (LH) the MIS sublay technique with associated CS may have represented an overtreatment., (Copyright © 2023 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Incisional hernia (HI), in open and laparoscopic surgery, is a very frequent complication. HI located in the umbilical region are called M3. The main aim of this study is to compare HI produced by the placement of an umbilical laparoscopic trocar (M3T) with those located in M3 in open surgery (M3O) in terms of basal characteristics, complications and recurrences; and secondarily the identification of risk factors., Method: Cross-sectional observational study based on the national prospective registry EVEREG during the period of July 2012-June 2018. The main variables were recurrences and postoperative complications. Both groups (M3T and M3O) were compared. Multiple logistic regression was performed to identify the risk factors of the entire cohort., Results: 882 had a follow-up time longer than 12 months. M3O group presented superior ASA-Class, more complex HI and previous repair. It also presented a higher recurrence rate at 12 and 24 months (8.6% vs. 2.5%; P < 0,0001 and 9.3% vs. 2.9%; P < 0.0001) and higher postoperative complications rate (21.9% vs. 14.6 %; P = 0.02). Previous repair, intervention length and associated procedures requirement were identified as risk factors for postoperative complications. Absence of a specialist present during surgery, previous repair, and the absence of complications were identified as risk factors for recurrence. In the PSM analysis no differences were detected in of complications and recurrences., Conclusions: HI M3O is more complex than M3T. The complexity is not related to the origin of the hernia but to its characteristics and those of the patient., (Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The results of parastomal hernia (PH) repair based on data from registries are scarce. The objective of this work is to analyze the data collected on PH in the National Registry of Incisional Hernia (EVEREG) and thus evaluate current practices and results in PH repair., Methods: Data from the PH cohort recorded in the period from July 2012 to June 2018 are analyzed. Complications, recurrences and associated factors of the entire PH cohort are analyzed, regardless of the type of stoma they are associated with. Subsequently, the same PH group analysis was performed in relation to a colostomy (larger group)., Results: 353 PH were studied. Of these, 259 (73%) were PH in the context of a terminal colostomy, 74 (21%) in the context of a terminal ileostomy, and 20 (6%) in the context of a ureteroileostomy (Bricker). The global mean age was 68.7 ± 11.1 years and 135 (38%) patients were female. The open approach and elective surgery were predominant (78% and 92% respectively); 99% were repaired with a non-absorbable synthetic mesh. Global postoperative complications were high (30.6%). As well as, the global recurrence (27.5%) after a mean follow-up of 9.4 months., Conclusions: PH repair is infrequent. PH surgery seems to be associated with a high percentage of postoperative complications and recurrence., (Copyright © 2020 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

The use of robot-assisted minimally invasive surgery in ventral/incisional hernia repair has increased exponentially in recent years. This increase is probably related to the advantages of robotic surgery, among which are better visualization, the implementation of articulated instruments and better ergonomics for the surgeon. The TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair) technique combines the benefits of minimally invasive surgery, in terms of less wound-related morbidity, also allowing the placement of a mesh in a retromuscular position facilitated by the use of the robotic platform., (Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Incisional hernia (HI), in open and laparoscopic surgery, is a very frequent complication. HI located in the umbilical region are called M3. The main aim of this study is to compare HI produced by the placement of an umbilical laparoscopic trocar (M3T) with those located in M3 in open surgery (M3O) in terms of basal characteristics, complications and recurrences; and secondarily the identification of risk factors., Method: Cross-sectional observational study based on the national prospective registry EVEREG during the period of July 2012 - June 2018. The main variables were recurrences and postoperative complications. Both groups (M3T and M3O) were compared. Multiple logistic regression was performed to identify the risk factors of the entire cohort., Results: 882 had a follow-up time longer than 12 months. M3O group presented superior ASA-Class, more complex HI and previous repair. It also presented a higher recurrence rate at 12 and 24 months (8.6 vs. 2.5%; p < 0,0001 and 9.3 vs. 2.9%; p < 0.0001) and higher postoperative complications rate (21.9 vs. 14.6%; p = 0.02). Previous repair, intervention length and associated procedures requirement were identified as risk factors for postoperative complications. Absence of a specialist present during surgery, previous repair, and the absence of complications were identified as risk factors for recurrence. In the PSM analysis no differences were detected in of complications and recurrences., Conclusions: HI M3O is more complex than M3T. The complexity is not related to the origin of the hernia but to its characteristics and those of the patient., (Copyright © 2021 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Pandemic by the COVID-19 has found us unprotected to provide an adequate and rapid sanitary response. The hospital network of our public health system has provided most of the resources for the treatment of patients affected by the infection. Non-essential (non-priority) surgeries have been postponed. The optimal and proportionate reestablishment of these non-priority surgeries can be a problem. This article offers a technical and non-technical view of reestablishment non-priority surgeries from the perspective of abdominal wall surgery., (© 2020 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Systematic reviews with meta-analysis are essential tools to reliably summarize the effectiveness of health interventions. A meta-analysis based exclusively on a small number of trials will often not be conclusive or may yield false positive results. The estimation of the optimal information size (OIS) can reduce the risk of obtaining false positive results and determine if additional clinical trials are required. The estimation of the OIS is very similar to that used to estimate the sample size of a clinical trial. The required number of participants for the meta-analysis should be at least as large as a single trial with adequate power. The OIS concept provides a statistical framework in which the accumulated information is convincing to indicate whether more clinical trials are needed to address the effects of the intervention., (Copyright © 2019 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Incisional hernias are a frequent complication, and their prevention includes proper closure of the abdominal wall., Methods: A prospective study was conducted at a third-level hospital after the introduction of a midline laparotomy closure protocol. An objective measurement of the suture length to incision length ratio was made. and the postoperative results were analyzed., Results: 127 patients were included and 34 of them (26.8%) had received a technically deficient closure. Incisional hernia was described in 20.5% of cases. An improvement in the quality of the abdominal wall closure was demonstrated over time., Conclusion: The abdominal wall closure was deficient in nearly one- quarter of the laparotomies performed at a third-level medical center. A protocol improved the quality of the laparotomy closure., (Copyright © 2019 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To determine the incidence of incisional hernia (IH) in the extraction incision (EI) in colorectal resection for cancer. To analyze whether the location of the incision has any relationship with the incidence of hernias and whether mesh could be useful for prevention in high-risk patients., Methods: Retrospective review of the colon and rectal surgery database from January 2015 to December 2016. Data were classified into 2groups, transverse (TI) and midline incision (MI), and the latter was divided into 2subgroups (mesh [MIM] and suture [MIS]). Patients were classified using the HERNIAscore. Hernias were diagnosed by clinical and/or CT examination., Results: A total of 182 out of 210 surgical patients were included. After a median follow-up of 13.0 months, 39 IH (21.9%) were detected, 23 of which (13.4%) were in the EI; their frequency was lower in the TI group (3.4%) and in the MIM group (5.9%) than in the MIS group (29.5%; p=0.007). The probability of developing IH in the MIS group showed an OR=11.7 (95%CI: 3.3-42.0) compared to the TI group and 4.3 (IC 95%: 1.1-16.3) versus the MIM group., Conclusions: The location of the incision is relevant to avoid incisional hernias. Transverse incisions should be used as the first option. When a midline incision is needed, a prophylactic mesh could be considered in high risk patients because it is safe and associated with low morbidity., (Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Registries are powerful tools for identifying factors predicting bad results. Our objective was to analyse data from the Spanish Registry of Incisional Hernia (EVEREG) to detect risk situations for the development of complications and recurrences., Methods: We have analysed data of the cohort of hernias registered during the period from July 2012 to June 2014. We have compared the data between complicated and non-complicated patients in the short and long term follow-up. Data compared were: patient demographics, comorbid condition, hernia defect characteristics and surgical technique to determine which of them may be predictors of poor outcomes., Results: During the period of study, we collected data from 1,336 hernias (43.7% males; 56.3% females) with a mean age of 63.6 years (SD 12.4) and BMI of 30.4 (SD 5.4). In the multivariate analysis, factors associated with complications were: age >70 years, previous neoplasm, diameter greater than 10cm, previous repair and bowel resection. Factors related with recurrences were: parastomal hernia, previous repair, emergency repair, postoperative complications and reoperation. A separation of components was the only protective factor for this type of analysis (OR 0.438; CI 0.27-0.71; p=0.0001)., Conclusions: Risk factors for the development of complications and recurrences must be considered for promoting preoperative patient prehabilitation, planning the surgical technique and referring patients to specialized abdominal wall units., (Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Incisional hernias are a very common problem, with an estimated incidence around 15-20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5-3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings. This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocar-site hernias and hernias developed after stoma closure are included in this review., (Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Incisional hernia (IH) after colorectal surgery is highly prevalent. The objective of this study is to assess the utility of an algorithm to decide on mesh augmentation after a midline laparotomy for colorectal resection to prevent IH in high-risk patients., Methods: A prospective study was conducted including all patients undergoing a midline laparotomy for colorectal resection between January 2011 and June 2014, after the implementation of a decision algorithm for prophylactic mesh augmentation in selected high-risk patients. Intention-to-treat analyses were conducted between patients in which the algorithm was correctly applied and those in which it was not., Results: From the 235 patients analysed, the algorithm was followed in 166 patients, the resting 69 cases were used as a control group. From an initial adherence to the algorithm of 40% in the first semester, a 90.3% adherence was achieved in the seventh semester. The incidence of IH decreased as the adherence to the algorithm increased (from 28 to 0%) with a time-related correlation (R 2 =0.781). A statistically significant reduction in IH incidence was demonstrated in high-risk groups in which the algorithm was correctly applied (10,2 vs. 46,3%; p=0,0001; OR: 7,58;95%; CI: 3,8-15). Survival analysis showed that the differences remained constant during follow-up., Conclusion: The implementation of the algorithm reduces the incidence of IH in high-risk patients. The adherence to the algorithm also correlates with a decrease in the incidence of IH., (Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The aim of this study was to the data from the National Registry of Incisional Hernia (EVEREG) to determine the reality of the treatment of this condition in Spain., Methods: EVEREG is an online prospective database which has been functioning since July 2012; operations for incisional hernia are anonymously recorded., Results: Up to March 2015, 4501 hernias from 95 of the 113 participating hospitals were registered. The mean age of the patients was 62.7, and 56.5% were women, with a mean BMI of 30.2kg/m 2 ; 29.8% presented a high surgical risk (ASA III-V). A total of 93.7% were scheduled surgeries, 88.3% open surgery and 22.2% were recurrent incisional hernias. There were 66.9% hernias after a midline laparotomy, and 81.4% of a transverse diameter of less than 10cm. A mesh was used in 96.2% of cases. Postoperative stay was 5.3 days and 29.1% presented a complication, with a mortality of 0.8%. After a median follow-up of 7.7 months a high rate of recurrence was detected (20.7% per year), especially in hernias that were operated on after a previous repair (18.1% primary vs. 30.6% recurrent; P=.004)., Conclusion: the EVEREG registry is a useful tool to know the current situation of incisional hernia treatment. Analysis of the data shows several points that could be improved: a low rate of follow-up and high recurrence rate., (Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure., (Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.)

Objective: To assess knowledge on the abdominal wall closure through a surgeon cohort survey., Methods: A twenty question individual questionnaire on laparotomy in elective surgery., Results: A total of 131 surgeons from seven hospitals responded (72% specialists and 28% in training). 71% of respondents estimated the frequency of incisional hernia to be higher than 15% and 54% considered the technique to be the most significant risk factor. 85% considered midline laparotomy closed with slow absorbable suture (57%) in a single layer (66%) to be the most appropriate technique. 67% believed retention sutures to be the appropriate prevention technique. 50% did not know or could not apply the 4:1 technique. 87% considered that an incisional hernia can be prevented and that the technique is the most important factor on which to act. 84% believed that a prosthesis can prevent the occurrence of incisional hernia, whereas 40% of respondents never use it and only 38% use it in patients at risk. On comparing surveys between specialists and residents, significant differences appeared in terms of a better understanding of the theoretical technical aspects in trainee surgeons., Conclusions: Although the results show an adequate understanding of the epidemiology and risk factors for development of incisional hernia, training and consensus measures are likely to be introduced in some basic technical aspects in order to improve results in laparotomy closure., (Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.)

Introduction: Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia., Materials and Methods: We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010., Results: Eight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up., Conclusions: Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair., (Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.)

The high incidence of parastomal hernia and the controversy surrounding its repair make its prevention an area of intense research. The aim of this article is to describe the modified Sugarbaker technique with a new mesh for the prevention of parastomal hernia using a laparoscopic approach., (Copyright © 2012 AEC. Published by Elsevier España, S.L. All rights reserved.)

Permanent synthetic materials are currently of choice for abdominal wall hernia repair. However, they are not ideal as short- and long-term complications with these have been reported. Extracellular matrix-derived biological implants (EMDBI) have emerged as a result of research and development into new materials. Several types of EMDBI have appeared in the last few years, each with its own manufacture characteristics and different from the rest. The current panorama of the xenogeneic EMDBI available in Spain is analysed, their complications, the unknown factors arising in the long-term, and the clinical experience available on incisional and inguinal hernias., (Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.)

There are different designs of prosthesis for use in the repair of incisional hernia, and it is often difficult to choose the most appropriate. The biological behaviour of the material must be a key part in the selection, although this behaviour will vary depending on what materials are available. A proper understanding of the relationship of the material with the abdominal wall dynamics is another important factor in this selection. Finally we need a stable repair without long term side effects. This paper analyses the prostheses more commonly available for incisional hernia surgery in the non-emergency situation., (Copyright © 2009 AEC. Published by Elsevier Espana. All rights reserved.)

At the present time the development of computers allows access to some three-dimensional models (3D) of physiological or pathological human situations obtained from patients with different medical or surgical problems. These models have a wide variety of applications: knowledge of the pathogenic mechanisms, help in diagnosis, planning of surgical strategies, training of surgical residents, teaching of medicine and surgery, design of devices and materials for use in medical and surgical practice or even distance interventions. Our objective is to design a 3D model of the inguinal region with the purpose of improving knowledge of the pathogenic mechanisms of inguinal hernia, the planning of surgical strategies and the teaching of the surgery of these hernias. They can also be used study the mechanical response of biomaterials into the abdominal wall.

The most frequent tumors that grow in the retrorectal space are embryological. Their management requires adequate knowledge of the characteristics of these lesions. We present five cases of retrorectal tumors.

We report the case of a 48-year-old man who was admitted to the intensive care unit for acute respiratory distress. After discharge, the patient showed massive pneumoperitoneum. None of the complementary investigations provided information on the cause. The patient underwent surgery but no intraoperative diagnosis was reached. We believe that this case is of interest since pneumoperitoneum is a frequent entity that often leads to emergency laparotomy. The cause is usually perforation, although in a substantial proportion of cases the pneumoperitoneum is non-surgical, or idiopathic.