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Purpose: Over the last decade, there has been a rapid rise in the development and refinement of abdominal wall repair (AWR) techniques. Numerous cadaveric AWR training courses have been set up with the goal of helping practicing surgeons learn and incorporate them into their surgical repertoire. Some maybe excellent but their quality and consistency are unknown. The aim of this article is to present a stepwise cadaveric dissection template and checklist to standardize all training on open AWR courses and to help course organizers benchmark the quality of their program. Methods: This article is based on both the authors experience as faculty and course leads of cadaveric AWR courses, and the published anatomical and operative literature. The authors represent the training committee of the European Hernia Society, and the AWR subcommittees of the British Hernia Society and Association of Coloproctology of Great Britain & Ireland. Results: A standardized stepwise approach for the cadaveric training of the most recognized procedures for open AWR, including retrorectus repair, posterior and anterior component separation techniques, is presented. Considerations on delegate selection, pre-course material and testing, course structure, and cadaveric models is also provided. Conclusion: Time and financial resources for surgeons to attend courses to learn and hone the skills required for safe effective AWR is limited. Ideally all courses should deliver up to date consistent training of the highest quality. One step to achieve this is by developing a standardized approach to ensure delegate understanding of the operative steps and key anatomical features. [ABSTRACT FROM AUTHOR]

Aim: Incisional herniation (IH) is a frequent complication following midline abdominal closure with significant associated morbidity. Randomized controlled trials have demonstrated that the small bites technique (SBT) and prophylactic mesh augmentation (PMA) may reduce IH compared to mass closure techniques, but data are lacking on their implementation in contemporary surgical practice. This survey aimed to evaluate the use of the SBT and PMA and to identify factors associated with their adoption. Method: Between 22 January 2023 and 16 March 2023, consultant surgeons across the UK were asked to complete a 25‐question survey on closure of an elective primary midline incision. Results: Responses were received from 267 of 675 eligible surgeons (39.6%) in 38 NHS Trusts. Respondents were evenly split between tertiary centres (47.6%) and district general hospitals (49.4%). SBT and PMA were used by 19.9% and 3.0% of respondents, respectively. Compared to other techniques, surgeons using the SBT were more likely to close the anterior aponeurotic layer only, use single suture filaments, 2–0 gauge sutures and sharp needle points and routinely dissect abdominal layers to aid closure (all p < 0.001). Attendance at lectures/conferences on SBT (p = 0.043) and basing practice on available evidence (p < 0.001) were independently associated with use of the SBT. The commonest barriers to adopting SBT were a perceived lack of evidence (23.8%) and belief that personal IH rates were low (16.8%). Conclusion: A minority of UK consultant surgeons have adopted the SBT or PMA. Practice change should be driven by more widespread dissemination of current evidence and procedural information. [ABSTRACT FROM AUTHOR]

Aim: The effect of negative pressure wound therapy (NPWT) on the pathogenesis and outcome of enteroatmospheric fistulation (EAF) in the septic open abdomen (OA) is unclear. This study compares the development and outcome of EAF following NPWT with that occurring in the absence of NPWT. Methods: Consecutive patients admitted with EAF following abdominal sepsis at a National Reference Centre for intestinal failure between 01 January 2005 and 31 December 2015 were included in this study. Patients were divided into two groups based on those that had been treated with NPWT and those that had not (non‐NPWT) and characteristics of their fistulas compared. Clinical outcomes concerning nutritional autonomy at 4 years and time to fistula development, size of abdominal wall defect and complete fistula closure were compared between groups. Results: A total of 160 patients were admitted with EAF following a septic abdomen (31‐NPWT and 129‐non‐NPWT). Median (range) time taken to fistulation after OA was longer with NPWT (18 [5–113] vs. 8 [2–60] days, p = 0.004); these patients developed a greater number of fistulas (3 [2–21] vs. 2 [1–10], p = 0.01), involving a greater length of small bowel (42.5 [15–100] cm vs. 30 [3.5–170] cm, p = 0.04) than those who did not receive NPWT. Following reconstructive surgery, nutritional autonomy was similar in both groups (77% vs. 72%) and a comparable number of patients were also fistula‐free (100% vs. 97%). Conclusions: Negative pressure wound therapy appears to be associated with more complex and delayed intestinal fistulation, involving a greater length of small intestine in the septic OA. This did not, however, appear to adversely affect the overall outcome of intestinal and abdominal wall reconstruction in this study. [ABSTRACT FROM AUTHOR]