Abstract:

Published in early 2025, the guidelines for the diagnosis and treatment of abdominal wall incisional hernia (2024 edition) has systematically introduced key concepts and technologies, including "conversion therapy" "three-dimensional suture" technique, and "complex abdominal wall status", for the first time. In terms of preoperative preparation, the 2024 edition innovatively proposed a conversion therapy strategy centered on botulinum toxin injection combined with progressive pneumoperitoneum. By increasing abdominal cavity volume and abdominal wall compliance preoperatively, this strategy converts patients with large incisional hernias who were originally high-risk or even contraindicated into operable candidates, significantly reducing the risks of abdominal compartment syndrome and postoperative complications. At the surgical technical level, laparoscopic "three-dimensional suture" has been incorporated into standardized procedures for the first time. The guideline emphasized defect closure and reconstruction of abdominal wall anatomical continuity, promoting a shift from traditional bridging repair to functional reconstruction in incisional hernia repair. Additionally, the guideline systematically defined the multidimensional risk factors of "complex abdominal wall status", highlighting the importance of multidisciplinary team and individualized surgical approach selection. It also proposed a threshold-based comprehensive assessment model for LOD (loss of domain), integrating abdominal wall compliance and dynamic imaging. Overall, with abdominal wall functional reconstruction as the core, the new edition established a more refined, safer, and biomechanically sound diagnostic and therapeutic system for incisional hernia. It provided important guidance for the standardized treatment of complex and large incisional hernias, and pointed out directions for future evidence-based research and technological innovation.

Key words: Incisional hernia, Diagnosis and treatment guideline, Interpretation