Use of >10 tacks doubles the incidence of early postoperative pain while having no effect on rates of recurrence. There was no difference in chronic postoperative pain comparing ML, TEP, and TAPP including when controlled for tack use.

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Background Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including ‘inlay’, ‘sublay’ and ‘underlay’, can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. Methods A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed. Results Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms ‘onlay’, ‘inlay’, ‘preperitoneal’ and ‘intraperitoneal’. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for ‘anterectus’, ‘interoblique’, ‘retro-oblique’ and ‘retromuscular’. Default consensus was achieved for the ‘retrorectus’ and ‘transversalis fascial’ planes. Conclusion Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.

corresponding segment in the saline-infused Wt controls. Immunohistochemistry with semiquantitative image analysis was used to identify inflammatory cells and measure the expression of matrix metalloproteinases (MMPs) in the aortic wall. Results: Wt and Akt2-/-mice had similar progressive increases in blood pressure during Ang II infusion. The Ang II-infused Akt2-/-mice had greater maximum aortic diameters in the ascending (P¼0.003), arch (P¼0.04), descending thoracic (P<0.001), suprarenal abdominal (P<0.001), and infrarenal (P¼0.003) aortic segments than the Ang II-infused Wt mice. Whereas no aneurysms formed in the Ang II-infused Wt mice or the saline-infused Akt2-/-mice, aortic aneurysms developed in 64% of the Ang II-treated Akt2-/-mice (P¼0.006). Of these mice, 27% had aneurysms in the ascending aorta, 14% in the arch, 9% in the descending thoracic aorta, 46% in the suprarenal abdominal aorta, and 7% in the infrarenal aorta. Additionally, 21% of the Ang II-infused Akt2-/-mice had fatal aortic rupture, always in the ascending segment. The media of affected aortic segments from Ang II-infused Akt2-/-mice exhibited significant infiltration of macrophages and CD3 + T cells, increased MMP-3 and MMP-9 expression ( Figure), and marked elastin destruction. Conclusions: Ang II infusion in Akt2-/-mice resulted in aortic aneurysm formation and rupture associated with inflammatory cell infiltration, increased MMP expression, and medial degeneration. These results indicate that Akt2 is protective against aortic aneurysm formation. Further studies are needed to investigate the mechanisms involved in Akt-mediated vascular protection, as well as to explore the possibility of inhibiting aneurysm formation/progression by activating Akt or increasing Akt sensitivity.

Background No standardized written or volumetric definition exists for 'loss of domain' (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri-and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons. Methods A Delphi study involving 20 internationally recognized abdominal wall reconstruction (AWR) surgeons was performed. Four written and two volumetric definitions of LOD were identified via systematic review. Panelists completed a questionnaire that suggested these definitions as standardized definitions of LOD. Consensus on a preferred term was pre-defined as achieved when selected by C80% of panelists. Terms scoring \20% were removed. Results Voting commenced August 2018 and was completed in January 2019. Written definition: During Round 1, two definitions were removed and seven new definitions were suggested, leaving nine definitions for consideration. For Round 2, panelists were asked to select all appealing definitions. Thereafter, common concepts were identified during analysis, from which the facilitators advanced a new written definition. This received 100% agreement in Round 3. Volumetric definition: Initially, panelists were evenly split, but consensus for the Sabbagh method was achieved. Panelists could not reach consensus regarding a threshold LOD value that would preclude surgery. Conclusions Consensus for written and volumetric definitions of LOD was achieved from 20 internationally recognized AWR surgeons. Adoption of these definitions will help standardize the use of LOD for both clinical and academic activities.