In 2014 the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias”. Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature.MethodsFor the development of the original guidelines all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based-Medicine. For the present update all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne) the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included.ResultsDue to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite still insufficient evidence with respect to these new techniques it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields.ConclusionGuidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initially guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.

Bochdalek hernia (BH) is a congenital defect of the diaphragm that usually presents in the neonatal period with life threatening cardiorespiratory distress. It is rare for BH to remain silent until adulthood. A 51-year-old woman presented with progressive dyspnea and abdominal symptoms, but without a history of trauma. The diagnosis of BH was made based on chest X-ray and CT. The hernia was repaired by the laparoscopic technique, and the patient made an uneventful recovery. This report validates the feasibility of laparoscopic repair of BH in an adult, which should be within the capability of an advanced laparoscopic surgeon.

Obesity is a major public health concern around the world, including Asia. Bariatric surgery has grown in popularity to combat this rising trend. An e-mail questionnaire survey was sent to all the representative Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) members of 12 leading Asian countries to provide bariatric surgery data for the last 5 years (2005-2009). The data provided by representative members were discussed at the 6th International APMBSS Congress held at Singapore between 21st and 23rd October 2010. Eleven nations except China responded. Between 2005 and 2009, a total of 6,598 bariatric procedures were performed on 2,445 men and 4,153 women with a mean age of 35.5 years (range, 18-69years) and mean BMI of 44.27 kg/m(2) (range, 31.4-73 kg/m(2)) by 155 practicing surgeons. Almost all of the operations were performed laparoscopically (99.8%). For combined years 2005-2009, the four most commonly performed procedures were laparoscopic adjustable gastric banding (LAGB, 35.9%), laparoscopic standard Roux-en-Y gastric bypass (LRYGB, 24.3%), laparoscopic sleeve gastrectomy (LSG, 19.5%), and laparoscopic mini gastric bypass (15.4%). Comparing the 5-year trend from 2004 to 2009, the absolute numbers of bariatric surgery procedures in Asia increased from 381 to 2,091, an increase of 5.5 times. LSG increased from 1% to 24.8% and LRYGB from 12% to 27.7%, a relative increase of 24.8 and 2.3 times, whereas LAGB and mini gastric bypass decreased from 44.6% to 35.6% and 41.7% to 6.7%, respectively. The absolute growth rate of bariatric surgery in Asia over the last 5 years was 449%.

Groin hernias are very common, and surgical treatment is usually recommended. In fact, hernia repair is the most common surgical procedure performed worldwide. In countries such as the USA, China, and India, there may easily be over 1 million repairs every year. The need for this surgery has become an important socioeconomic problem and may affect health-care providers, especially in aging societies. Surgical repair using mesh is recommended and widely employed in Western countries, but in many developing countries, tissue-to-tissue repair is still the preferred surgical procedure due to economic constraints. For these reason, the development and implementation of guidelines, consensus, or recommendations may aim to clarify issues related to best practices in inguinal hernia repair in Asia. A group of Asian experts in hernia repair gathered together to debate inguinal hernia treatments in Asia in an attempt to reach some consensus or develop recommendations on best practices in the region. The need for recommendations or guidelines was unanimously confirmed to help overcome the discrepancy in clinical practice between countries; the experts decided to focus mainly on the technical aspects of open repair, which is the most common surgery for hernia in our region. After the identification of 12 main topics for discussion (indication, age, and sex; symptomatic and asymptomatic hernia: type of hernia; type of treatment; hospital admission; preoperative care; anesthesia; surgical technique; perioperative care; postoperative care; early complications; and long-term complications), a search of the literature was carried out according to the five levels of the Oxford Classification of Evidence and the four grades of recommendation.

This article was updated to include the middle initial of author L. N. Jorgensen's name.