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Operative classification of ventral abdominal hernias: new and practical classification. Yasser Selim. From the Ministry of Health.Background: Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system for ventral hernias. One of the more accepted classification systems is that of the European Hernia Society (EHS). Its limitation is that it does not include individual patient risk factors and wound classification. The aim of this work was to find out the basic principles of hernia etiology and pathogenesis, clarify the factors that are important in treatment of ventral hernias, and categorize hernia patients according to those factors. Methods: This retrospective study included 238 patients who presented to our surgery department between 2010 and 2020. A full description of ventral hernias was made, including their type according to the EHS. In addition, abdominal wall components were assessed, including strength of rectus muscles, lateral abdominal muscles, and abdominal fascia, namely the linea alba. Patients with spontaneous hernias were grouped according to the size of the defect and the condition of the rectus abdominis muscles, the fascia and other abdominal muscles. Results: Patients were put into 6 clinical categories: type 1A, type 1B, type 2, type 3, type 4, and type 5. The grouping of patients was done according to the factors we believed affect the choice of surgical procedure and the prognosis of repair. Patients with types 1 and 2 have normal abdominal muscles, whereas those with types 3 and 4 have weak muscles and weak stretched fascia (linea alba). Type 5 includes incisional hernias. Conclusion: The primary purpose of any classification should be to improve the possibility of comparing different studies and their results. By describing hernias in a standardized way, different patient populations can be compared. Numerous classifications for groin and ventral hernias have been proposed over the past 5-6 decades. For primary abdominal wall hernias, there was agreement with EHS classification on the use of localization and size as classification variables.

Background Inguinal hernia recurrences (IHR) are relatively common and have higher complexity and complication risk at reoperation when compared with primary inguinal hernias (PIH). This study aims to further characterize the patterns of recurrence and early complications observed by type of hernia repair at the index surgery. Methods After REB approval, a review of charts from patients undergoing elective first reoperation for IHR from 2013–2017 was performed. First operations were classified as: childhood repair, laparoscopic repair, open tissue repair, open mesh repair and Shouldice repair. Early complication included hematoma, infection and seroma. Statistical analyses were completed. Results A total of 1281 patients underwent 1340 surgeries for IHR in the study period (4.9% of all inguinal hernias operated). There wa an increased proportion of males, direct type hernias and wound infection in IHR group (p<.001) when compared with PIH repairs. During surgical procedure, the length of surgery was longer, scarring of tissues heavier, nerve identification lower in patients with previous open mesh and Shouldice repairs, in comparison to other groups (childhood, laparoscopic and open repair - p<.001). Conclusion Recurrent inguinal hernia repairs present higher complexity than PIH repairs and incurr in higher chances of early postoperative complications. The type of PIH repair technique influences surgical difficulties encountered in the open reoperation, with open mesh and Shouldice techniques being associated with higher surgical difficulty. This information may help in surgical planning, according with the anticipated leverl of procedure difficulty.

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