Groin hernia is one of the most common surgical conditions worldwide. Clinical examination can reveal the majority of inguinal hernias. Small inguinal and femoral hernias (in women) may be missed. Dynamic inguinal ultrasound (DIUS) can fill this diagnostic gap. A standardized technique of DIUS is, therefore, important and will be described. The results show high specificity (0.9980) and sensitivity (0.9758), demonstrating the value of the method (which is known to be highly examiner dependent).

Intraoperative fascial traction (IFT) for treatment of large ventral hernias. A retrospective analysis of 50 casesObjective: The aim was to evaluate the effectiveness, clinical practicability, and complication rate of the intraoperative fascial traction (IFT) procedure for the treatment of large ventral hernias. Method: This study evaluated 50 patients from 11 specialized centers with an intraoperatively measured fascial distance of more than 8 cm, who were treated by IFT (traction time 30-35 min) using the fasciotens ® hernia traction procedure.Results: Fascial gaps measured preoperatively ranged from 8 cm to 44 cm, with most patients (94%) having a fascial gap above 10 cm (W3 according to the European Hernia Society classification). The mean fascial distance was reduced from 16.1 ± 0.8 cm to 5.8 ± 0.7 cm (stretch gain 10.2 ± 0.7 cm, p < 0.0001, Wilcoxon matched-pairs signedranks test). A reduction in fascial distance of at least 50% was achieved in three quarters of the patients and in half of the treated patients the reduction in fascial distance amounted to even more than 70%. The closure rate achieved by IFT after a mean surgical duration of 207.3 ± 11.0 min was 90% (45/50). Hernia closure was performed in all cases with a mesh augmentation in a sublay position. Postoperative complications occurred in 6 patients (12%). A reoperation was required in 3 patients (6%). Conclusion:The described IFT method is a new procedure for abdominal wall closure in large ventral hernias. The presented results demonstrate a high effectiveness, a good clinical practicability and a low complication rate of IFT.

Large incisional hernias are a permanent problem for surgeons in a growing number of operations. For the treatment of complex hernias, there are no internationally accepted evidence-based recommendations regarding the restoration of abdominal wall integrity. In this paper, we are reviewing the development of different component separations (CS) and other techniques used in treating such conditions. A literature review was carried out to describe some important techniques to treat giant hernias. After a detailed description of the CS and its important modifications, we are describing and discussing the relatively new fascial traction technique with its modification. With these reviews of the mentioned studies, we are questioning the extent to which the CS is still indicated in treating giant hernias and point out the importance of further comparison studies evaluating different techniques.

Aim We present our approach of treating a W3 (EHS-Classification) incisional hernia with heterotopic ossification in the abdominal wall. Material and Methods a 62-years-old female patient presented with a hernia in her inverted-T incision (midline and transverse) after undergoing multiple laparotomies. The CT-scan showed calcified structures within the abdominal wall. We planned the extensive reconstruction after preoperative Botox injections. Results The 20x25 cm hernial sack contained parts of the stomach and colon. The dissection of the midline and transverse scars was challenging with the needed removal of scattered pieces of heterotopic bone tissues. After dissecting the retro-muscular space, the fascial edges were 25 cm apart. With bilateral transversus abdominis release (TAR), It was reduced to 20 cm. The posterior fascia was approximated, leaving a central 12 cm defect, and a smaller lateral defect, which we covered using open-IPOM and underlay techniques respectively. A 30x40 cm mesh in sublay position was placed and fascial traction was applied on the anterior fascia. With the resulting defect of 16 cm, a tension-free closure was still not possible, and we bridged the gap with a mesh in inlay position. Conclusions Despite combining pre-operative Botox injection and fascial traction with TAR, complete closure of the fascia was not possible. IPOM, sublay, underlay and inlay bridging were needed. Specialized hernia surgeons should be familiar with a wide range of different techniques to deal with such cases.