Background: There are no valid recommendations or reliable guidelines available to guide patients how long they should refrain from lifting weights or returning to heavy physical labor after abdominal or hernia surgery. Recent studies found that surgeons’ recommendations not to be evidence-based and might be too restrictive considering data on fascial healing and incisional hernia development. It is likely that this impairs the patient’s quality of life and leads to remarkable socio-economic costs. Hence, we conducted this survey to gather international expert’s opinions on this topic. Materials and methods: At the 41st Annual International Congress of the EHS, attending international experts were asked to complete a questionnaire concerning recommendations on given proposals for postoperative refrain from heavy work or lifting after abdominal surgery and also after hernia repairs. Results: In total, 127 experts took part in the survey. 83.9% were consultants with a mean experience since specialization of more than 11 years. Two weeks of no heavy physical strain after laparoscopic surgery were considered sufficient by more than 50% of the participants. For laparotomy, more than 50% rated 4 weeks appropriate. For mesh-augmented sublay and IPOM repair of ventral or incisional hernias, more than 50% rated 4 weeks of rest appropriate. For complex hernia repair, 37% rated 4 weeks reasonable. Two weeks after, groin hernia surgery was considered sufficient by more than 50% of the participants. Conclusion: Following groin hernia repair (Lichtenstein/endoscopic technique) and laparoscopic operation, the majority agreed on the proposal of 2 weeks refraining from physical strain. Four weeks of no physical strain were considered appropriate by a majority after laparotomy and open incisional hernia repair. However, the results showed substantial variation in the ratings, which indicates uncertainty even in this selected cohort of hernia surgery experts and emphasizes the need for further scientific evaluation. This is particularly remarkable, because a lack of evidence that early postoperative strain leads to higher incisional hernia rates. Trial registration: Number DRKS00023887.

Purpose: Incisional hernias (IH) represent common complications following abdominal surgeries, with emergency repair associated with increased morbidity and mortality. This scoping review aimed to map the existing literature on emergency incisional hernia repair, identify research gaps, and inform future guideline development. Methods: A comprehensive literature search was conducted in PubMed MEDLINE and SCOPUS for studies published between January 2000 and August 2024. Articles addressing any aspect of emergency incisional hernia repair in adults were included. Data extraction focused on study characteristics, patient demographics, surgical approaches, and outcomes. Results: Of 801 unique articles identified, 73 met the inclusion criteria. Most were cohort studies (73.97%), with only one randomized trial. The primary areas of interest were repair methods (47.95%), operative outcomes (31.51%), risk assessment (16.44%), and diagnosis (5.48%). Pooled analysis revealed a predominantly female (63%), elderly (mean age 62.3 years), and comorbid patient population. The most frequent study endpoints were readmission (18%), surgical site infection (12%), reoperation (8%), and mortality (4%). Significant heterogeneity was observed in defect characterization and surgical techniques. Conclusion: This review highlights a paucity of randomized studies guiding emergency incisional hernia management. Key issues identified include inconsistent definitions of emergency presentation, limited data on hernia characteristics, and a lack of standardized outcome reporting. Future research should focus on developing a unified classification system for emergency incisional hernias, evaluating the role of imaging in decision-making, and conducting comparative studies on various treatment strategies across different clinical scenarios.

Open abdomen therapy has become a commonly used strategy in the treatment of serious abdominal conditions. A potential major complication is the development of enteroatmospheric fistula, as it has been linked to increased mortality and morbidity^1,2. Vacuum-assisted wound closure and mesh-mediated fascial traction has been demonstrated to be a safe technique when applied correctly^3,4. To reduce the risk of fistula development, the use of an inert film (visceral protective layer, VPL) between the vulnerable intestines and dressing material/mesh might be beneficial^4,5. This study aimed to define the effect of VPL application on the incidence of enteroatmospheric fistula during open abdomen therapy based on a large registry data set.

Objectives: To evaluate the value of virtual monoenergetic images (VMI) from photon-counting detector CT (PCD-CT) for discriminability of severe lung injury and atelectasis in polytraumatized patients. Materials & Methods: Contrast-enhanced PCD-CT examinations of 20 polytraumatized patients with severe thoracic trauma were included in this retrospective study. Spectral PCD-CT data were reconstructed using a noise-optimized virtual monoenergetic imaging (VMI) algorithm with calculated VMIs ranging from 40 to 120 keV at 10 keV increments. Injury-to-atelectasis contrast-to-noise ratio (CNR) was calculated and compared at each energy level based on CT number measurements in severely injured as well as atelectatic lung areas. Three radiologists assessed subjective discriminability, noise perception, and overall image quality. Results: CT values for atelectasis decreased as photon energy increased from 40 keV to 120 keV (mean Hounsfield units (HU): 69 at 40 keV; 342 at 120 keV), whereas CT values for severe lung injury remained near-constant from 40 keV to 120 keV (mean HU: 42 at 40 keV; 44 at 120 keV) with significant differences at each keV level (p < 0.001). The optimal injury-to-atelectasis CNR was observed at 40 keV in comparison with the remaining energy levels (p < 0.001) except for 50 keV (p > 0.05). In line with this, VMIs at 40 keV were rated best regarding subjective discriminability. VMIs at 60–70 keV, however, provided the highest subjective observer parameters regarding subjective image noise as well as image quality. Conclusions: Discriminability between severely injured and atelectatic lung areas after thoracic trauma can be substantially improved by virtual monoenergetic imaging from PCD-CT with superior contrast and visual discriminability at 40–50 keV.

Zusammenfassung: Eine geplante ventrale Hernie nach einer offenen Bauchbehandlung ist eine seltene Hernienentität, da aufgrund bereits etablierter Konzepte zur offenen Bauchbehandlung die Faszienverschlussrate gesteigert werden konnte. Nichtsdestotrotz gelingt ein Faszienverschluss nicht immer und eine geplante ventrale Hernie muss zu einem späteren Zeitpunkt operativ versorgt werden. Die Bauchdeckenrekonstruktion ist anspruchsvoll und bedarf der sorgfältigen präoperativen Vorbereitung.In einer monozentrischen retrospektiven Analyse wurden alle Narbenhernien von 2013 bis 2023 (n = 632) identifiziert. Komplexe Narbenhernien im Sinne geplanter ventraler Hernien nach einem Laparostoma (n = 11) wurden selektiert. Die präoperative Diagnostik und OP-Planung wurden den Patientenakten entnommen; OP-Techniken anhand der Operationsberichte analysiert. Die Literaturrecherche erfolgte auf PubMed (Medline).Präoperativ wurden in allen Fällen neben einer körperlichen Untersuchung eine Abdomensonografie, ein CT-Abdomen und eine Koloskopie durchgeführt. Indikationen für ein Laparostoma waren vor allem Darmperforationen mit Peritonitis, ein abdominelles Kompartment, postoperative Fasziendehiszenzen („Platzbauch“) sowie Folge eines stumpfen oder penetrierenden Traumas. Die Größe der Bauchwanddefekte betrug im Median horizontal 13 cm (6–35 cm) und vertikal 18 cm (10–28 cm). Seit 2018 wurde (6/11) präoperativ nach standardisiertem Schema Botulinumtoxin A injiziert. Bei allen Patienten gelang intraoperativ der mediane Faszienverschluss. Die Operationstechniken umfassten Sublay-, IPOM- und Sandwich-Repair sowie intraoperative Faszientraktion und Komponentenseparation.Eine geplante ventrale Hernie nach einer offenen Bauchbehandlung ist eine komplexe Hernie, für die ein breites hernienchirurgisches Armamentarium benötigt wird. Die umfassende präoperative Optimierung inkl. Botulinumtoxin-Infiltration sollte bei derart anspruchsvollen Hernien unbedingt erwogen werden, um die anatomiegerechte Rekonstruktion durch einen Mittellinienverschluss mit Netzaugmentation zu erreichen.