DIFFICULT INCISIONAL HERNIA NOSOLOGICAL SETTINGS AND APPROACH STRATEGIES

Even in the age of minimally invasive surgery, incisional hernias remain frequent complications where standard resolution is alloplasty in various technical variants. The revolution brought by the introduction of synthetic materials is overshadowed by the unsatisfactory results obtained in some lesional types that seem to go beyond the nosological framework of standard incisional hernias and which can be reunited under the name of difficult incisional hernias. Our work attempts to make a conceptual clarification in a lesional amalgam through the two compulsory targets required for surgical correction: to solidly cover the parieto-abdominal defect and to maintain intra-abdominal postoperative pressure to values that did not trigger the pathophysiological cascade of intraabdominal hypertension.