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the literature with a network meta-analysis. Surg Endosc. 2012;26(12):3355–66. https://doi.
org/10.1007/s00464-012-2382-5.
9. Merskey H, Bogduk N.Classication of chronic pain. Description of pain terms. Prepared by
the International Association for the Study of pain, Subcommittee on Taxonomy. Pain Suppl.
1986;3:1–226.
10. Aleri S, Amid PK, Campanelli G, etal. International guidelines for prevention and manage-
ment of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15(3):239–
49. https://doi.org/10.1007/s10029-011-0798-9.
11. Nienhuijs SW, Rosman C, Strobbe LJA, Wolff A, Bleichrodt RP. An overview of the fea-
tures inuencing pain after inguinal hernia repair. Int. J.Surg. 2008;6(4):351–6. https://doi.
org/10.1016/j.ijsu.2008.02.005Hernia. 2014 Apr;18(2):151-63. https://doi.org/10.1007/
s10029-014-1236-6. Epub 2014 Mar 20.
12. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA,
Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery
A, Simmermacher RK, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels
T, Kingsnorth A. Classication of primary and incisional abdominal wall hernias. Hernia.
2009;13:407–14.
13. Vorst AL, Kaoutzanis C, Carbonell AM, Franz MG.Evolution and advances in laparoscopic
ventral and incisional hernia repair. World J Gastrointest Surg. 2015;7:293–305.
14. Cuccurullo D, Piccoli M, Agresta F, Magnone S, Corcione F, Stancanelli V, Melotti
G.Laparoscopic ventral incisional hernia repair: evidence-based guidelines of the rst Italian
consensus conference. Hernia. 2013;17:557–66.
15. Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F, Kukleta
J, Leblanc K, Lomanto D, Misra MC, Bansal VK, Morales-Conde S, Ramshaw B, Reinpold
W, Rim S, Rohr M, Schrittwieser R, Simon T, Smietanski M, Stechemesser B, Timoney M,
Chowbey P, International Endohernia Society (IEHS). Guidelines for laparoscopic treatment
of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-
part 1). Surg Endosc. 2014;28(1):2–29.
16. Silecchia G, Campanile FC, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L, Olmi S, Ferrari
GC, Cuccurullo D, Baccari P, Agresta F, Vettoretto N, Piccoli M.Laparoscopic ventral/inci-
sional hernia repair: updated Consensus Development Conference based guidelines. Surg
Endosc. 2015;29:2463–84.
17. Ramirez OM, Ruas E, Dellon AL.Component separation method for closure of abdominal
wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86:519–26.
18. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ.Transversus abdominis muscle release: a
novel approach to posterior component separation during complex abdominal wall reconstruc-
tion. Am J Surg. 2012;204:709–16.
19. Hodgkinson JD, Leo CA, Maeda Y, Bassett P, Oke SM, Vaizey CJ, Warusavitarne J.A meta-
analysis comparing open anterior component separation with posterior component sepa-
ration and transversus abdominis release in the repair of midline ventral hernias. Hernia.
2018;22(4):617–26. https://doi.org/10.1007/s10029-018-1757-5.
20. Dauser B, Ghaffari S, Ng C, Schmid T, Köhler G, Herbst F.Endoscopic anterior component
separation: a novel technical approach. Hernia. 2017;21:951–5.
21. Malik K, Bowers SP, Smith CD, Asbun H, Preissler S.A case series of laparoscopic components
separation and rectus medialization with laparoscopicventral hernia repair. J Laparoendosc
Adv Surg Tech. 2009;19:607–10.
22. Deerenberg EB, Timmermans L, Hogerzeil DP, slieker JC, Eilers PHC, Jeekel J, Lange JF.A
systematic review of the surgical treatment of large incisional hernia. Hernia. 2015;19:89–101.
23. Koscielny A, Widenmayer S, May T, Kalff J, Lingohr P. Comparison of biological and allo-
plastic meshes in ventral incisional hernia repair. Lancgenbecks Arch Surg. 2017;403(2):255–
63. https://doi.org/10.1007/s00423-017-1639-9.
24. Trippoli S, Caccese E, Tulli G, Ipponi P, Marinai C, Messori A. Biological meshes for
abdominal hernia: lack of evidence-based recommendations for clinical use. Int. J. Surg.
2018;52:278–84.
U. Bracale et al.
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© Springer Nature Switzerland AG 2019
D. P. Greco, E. Borgonovi (eds.), Abdominal Wall Surgery,
https://doi.org/10.1007/978-3-030-02426-0_17
V. Beretta (*)
Department of Economics and Management, University of Pavia, Pavia, Italy
e-mail: valentina.beretta02@universitadipavia.it
M. Tringali
Hospital Programming Unit, HTA Ofce, Regional Government Health Care Directorate,
Lombardy Region, Italy
e-mail: michele_tringali@regione.lombardia.it
A. Marioni
Surgery Department, University Hospital of Pisa, Pisa, Italy
e-mail: a.marioni@ao-pisa.toscana.it
17
Health Technology Assessment
inAbdominal Wall Surgery
ValentinaBeretta, MicheleTringali, andAntonioMarioni
17.1 Introduction totheTechnologies used
inAbdominal Wall Surgery
Abdominal wall surgery can be performed using different technologies.
First, open surgery refers to the cases in which the surgeon made an incision to
expose the entire operative area. This technology allows the repair of the defect by
placing, in the majority of the cases, a mesh over the abdominal opening. While usually
synthetic or plastic mesh is adopted, in the case of severe circumstances bioprosthetic
mesh are implemented and will become an integral part of the body over few weeks.
Second, laparoscopic surgery occurred when a slender tool with a tiny camera
and light is inserted in the abdominal cavity. Patients can benet from laparoscopic
surgery in terms of early recovery, while medical institutions can benet of the lower
costs associated with a shorter length of stay [1]. But, on the other side, among the
disadvantages, higher attention to avoid damages to the internal structures is needed
[2]. In addition, meticulous attention is needed for blood aspiration [2]. This implies
that many procedures are more difcult for surgeon to perform [1]. In fact, even if the
quality of image and video provided is excellent, it requires a longer and more spe-
cic training for professionals, with a learning curve longer than open surgery.
192
Third, robotic surgery is used when miniaturized surgical instruments are
used instead of previously described techniques. It has been introduced to poten-
tially overcome some of the limitations connected to the laparoscopic surgery [1,
3]. Many advancements are associated with the use of robotic support in per-
forming the operation: “The view is spectacular, the movements are intuitive,
and, during a case with a long operative time, the chair is like a rst-class seat on
a transcontinental ight” ([3], p.19S). While the major advantage of the robot
surgery is that also professionals without laparoscopic competences can approach
and adopt this technology, it is somewhat surprising that the dominant trend of
diffusion of robot surgery is not from open surgery but from conventional lapa-
roscopic surgery, as registered in the USA [4] and in Italy [5]. On the contrary,
the main disadvantage of the robotic surgery is undoubtedly the costs associated
with the technology [6, 7].
17.2 How tocompare different Technologies?
Previous studies in the literature analyzed the main differences across different
techniques that can be adopted to perform abdominal wall surgery.
17.2.1 Open Surgery andLaparoscopic Surgery
According to Jain and Jain, similar results between open and laparoscopic surgery
have been found [8]. However, small differences have been detected in the
literature:
• Groin pain is higher in open surgery with respect to laparoscopic repair. This
causes patients to be restricted from daily physical and sporting activities [8];
• Higher operating time in laparoscopic surgery [1, 8–10];
• Higher complications in laparoscopic surgery than open one, caused by long
learning curve [8, 11];
• Even if the assessment of the costs associated with different procedure is dif-
cult, since they mainly depend on institutional policies and procedures [12],
laparoscopic surgery is associated with higher reimbursement [13, 14].
Despite these small differences, the choice between the two approaches is dic-
tated by the preferences of surgeons and circumstances, since there is no evidence
in the literature for a clear superior procedure [8].
17.2.2 Open Surgery andRobotic Surgery
Very little is known about the comparison between open surgery and robotic sur-
gery, since the latter is meant to compete with or replace laparoscopic surgery [1].
V. Beretta et al.
193
The study conducted by Menon etal. in 2002 found that, while similar results have
been found for the features before the surgery, its duration, and the pathological
stages, the outcomes differ signicantly, favoring robotic surgery [15].
17.2.3 Laparoscopic Surgery andRobotic Surgery
This is the area of major interest since robotic surgery is intended to replace laparo-
scopic one [1]. According to D’Annibale etal., robotic and laparoscopic techniques
can obtain similar results in terms of operativity and postoperative outcomes [7].
However, since the operating times related to the robotic surgery are longer, advan-
tages that are able to justify the choice of conducting robotic surgery are needed [1].
In this regard, results of previous studies are controversial.
Some authors found that only little advantages are provided by robotic surgery
with respect to laparoscopic surgery [1]. Others found that in certain stages of the
surgical procedure, the dexterity and the exibility of robotic surgery may be advan-
tageous for the surgeon [7]. Finally, the greatest advantage is related to the possibil-
ity for the surgeon to stay at the console, which is connected to more comfortable
workplace, less fatigue, and enhanced ability to perform ne tasks [1].
In summary, robot-assisted mininvasive surgery can provide some benets to
surgeons, scarce benets to health care organizations (but at higher costs), and ques-
tionable, if any, benets to patients, with some exceptions, e.g., reduced blood loss
and transfusion requirements at least in some indications [5, 16, 17].
17.3 Health Technology Assessment forAbdominal
Wall Surgery evaluation
Despite previous studies for the comparison of different technologies used in per-
forming abdominal wall surgery exist in the literature, there is a lack of systematic
comparison between them. As identied in previous studies, cost is considered the
most important barrier for performing robotic surgery [6, 7], but additional studies
are need in order to evaluate the efcacy, the effectiveness, and the cost- effectiveness
of using this technique [7]. In fact, as highlighted by Gutt etal., trials are needed
in order to evaluate the benets of robotic surgery since the literature available
does not produce valuable support to the modern evidence-based medicine [1, 3].
In fact, even if technological advancements are changing the abdominal surgery
practice [3], clear advantages for transiting from one practice to robotic surgery are
needed [1].
In this sense, Health Technology Assessment (HTA) would provide a useful tool
for the systematic assessment of different technologies. HTA aims at systematically
evaluating the properties, effects, and impacts of health technologies, in order to
support policy-makers in taking decisions [18]. Over the years, many denitions of
HTA have been provided in the literature, underlying different aspects of the topic.
In particular, the World Health Organization dened HTA as a multidisciplinary
17 Health Technology Assessment inAbdominal Wall Surgery
194
process aimed at evaluating the different implications (from clinical to economic) of
a health technology for supporting decision-making processes (World Health
Organization). Also, EUnetHTA provided a denition of HTA, considered as the
process that evaluates health technologies in a systematic, transparent, unbiased,
and robust manner (EUnetHTA).
The importance of technology assessment (TA) raised in the 1960s, because of
the critical role of the technology in the society [18]. Subsequently, in 1965, the role
of TA has been claried by the congressman Emilio Daddario, during the delibera-
tions of the Committee on Science and Astronautics of the US House of
Representatives, who afrmed that the purpose of TA was to serve policy-makers in
taking decisions, considering social, economic, and legal implications of any course
of action [18]. In 1969, TA was dened as a support tool aimed at aiding the
Congress in fully considering both the private and the public interests when assess-
ing a new technology, in order to maximize the society’s welfare [19].
During the 1970s, there has been a growing interest in the topic by many
scholars. In particular, there was the necessity to nd a common and shared
meaning for the term “technology” and to dene the role of technology assess-
ment. At this purpose, Galbraith, in 1977, dened technology as “the systematic
application of scientic or other organized knowledge to practical tasks” [20],
while Brooks and Bowers, in 1970, stated that TA was aimed at identifying both
the intended effects of technologies and the unintended social, economic, and
environmental effects [21].
Subsequently, the TA started being applied to other elds of research. In particu-
lar, after the Congress in 1967, the Ofce of Technology Assessment was autho-
rized, founded in 1973, operationalized in 1974, and adopted in the health programs
in 1975. Just in 1976, the rst Ofce of Technology Assessment (OTA) Health
Program report was issued, as a proof of the fact that, before the advent of HTA,
health technologies were analyzed in terms of safety, effectiveness, and cost [18].
The spread of HTA in the rest of the world occurred starting from the 1980s [22].
In the late 1980s, the establishment of the Swedish Council on Technology
Assessment in Health Care (SBU) represents an important step towards the diffu-
sion of HTA in Europe [22]. The HTA showed a rapid dissemination outside the
boundaries of the USA, and, in particular, in Europe, where several countries have
established agencies to perform HTA in order to set priorities [23].
After the rst application of the term, many steps have been undertaken to rein-
force the knowledge of HTA.It was especially in the 1980s and 1990s when, the
emerging concern about the real effectiveness of health technologies and the sharp
increase in health expenditures gave assistance to the development of HTA in
Europe [24, 25].
In 1992, the Cochrane Collaboration (CC) has been established as a worldwide
network of centers and people aiming at critically reviewing the literature related to
health care effects of healthcare interventions. The objective of the collaboration is
to provide a database in which extensive and accurate information are provided to
physicians in order to make decisions [26].
In the following years, a number of forces have driven the development of HTA [27]:
V. Beretta et al.
195
• Robust science upon which to base the choice of interventions was needed. In
fact, as the Department of Health stated in 1991, there were many categories of
health technologies [28]:
– Ineffective widely used technologies;
– Valuable technologies introduced in delay;
– New technologies falsely promoted over existing ones;
– Technologies with a variation in their value.
Because of the existence of nonvaluable technologies, decision-makers had to
provide evidence of the value of the new health technologies, in order to reduce
waste in monetary and nonmonetary terms;
• Costs containment was required since the unit cost of new technologies was usu-
ally higher with respect to the technologies they replaced;
• The rise in consumers’ expectations increased both the use and the demand for
better information.
Despite many advancements have been done in HTA in the last years, many col-
laborations are now in place, and many health technologies are now subject to
assessment, there is a scarcity of literature focusing on the application of HTA pro-
cesses to robotic abdominal wall surgery.
The most widespread technology used in abdominal wall robotic surgery is the
Da Vinci robot. Even if no HTA reports have been identied, different systematic
reviews exist [1, 5, 16, 17, 29, 30].
Results of these studies found that robotic surgery with Da Vinci robot is secure
and feasible, and that the associated mortality and morbidity rates are low. The dura-
tion of the operation is higher with respect to open surgery, while lower with lapa-
roscopic surgery. In particular, a faster learning curve is associated with robotic
surgery with respect to laparoscopic surgery. However, no specic advantages for
the patients have been found using this technique [29].
In addition, the potential of HTA can be even enhanced with the support of the
hernia registries. Different alternative classications of hernias have been proposed
and tested in the literature [31–36], with the aim of supporting future guidelines and
therapeutic choices with most valuable and important risk factors [37]. Despite reg-
istries vary according to the classication factors that are considered, the main aim
of any classication should be the improvement of extent to which different studies
and related results can be compared [37]. At this purpose, the existence of registries
allows the development of evidence-based guidelines [37] that, together with HTA
reports, should be at the basis of investment choices for the introduction of new
technologies in healthcare systems, and/or for public procurement procedures.
17.4 HTA inAbdominal Wall Surgery: theTuscany Case
Abdominal wall reconstructive surgery in recent years has had a positive impulse.
Open anterior treatment remained the gold standard in the reconstruction of the
midline for the treatment of primitive or incisional abdominal wall hernia.
17 Health Technology Assessment inAbdominal Wall Surgery
196
Laparoscopic surgery determines a bridge treatment without reconstruction of
the midline.
In the last few years, with the advent of robot-assisted surgery, the treatment of
incisional or primitive abdominal wall hernias has been seen again with positioning
of the extra-abdominal retromuscular prosthesis and reconstruction of the midline.
In Tuscany, thanks to the collaboration of University Hospital of Pisa and
Grosseto Hospital, this technique plays an important role in the treatment of the
abdominal wall hernia.
The decision algorithm we developed is as follows:
1. Incisional or primitive abdominal wall hernia with a <5-cm hole with the remain-
ing wall functionally effective in an obese subject or with associated pathology:
IPOM PLUS.
2. Incisional or primitive abdominal wall hernia with a 5–10-cm hole: repair with
placement of a retromuscular prosthesis according to Rives–Stoppa with anterior
open technique or in selected cases with a robot-assisted technique.
3. Incisional or primitive abdominal wall hernia with a hole between 10 and 15cm:
endoscopic components separation and subsequent repair according to Rives–
Stoppa with retromuscular prosthesis with anterior open technique or in selected
cases with robot-assisted technique.
4. Incisional or primitive abdominal wall hernia with >15-cm hole is performed:
posterior component separation with transversus abdominis release with anterior
open technique or in selected robot-assisted cases.
5. Abdominal wall hernia associated with muscular diastasis (hernia of abdominal
wall associated with muscular diastasis): midline reconstruction with traditional
open technique with placement retromuscular prosthesis and dermolipectomy or
abdominoplasty, and in selected cases with muscular diastasis <5cm and abdomi-
nal hernia reconstruction of the median line with robot-assisted Costa technique.
The Tuscany group experience (Antonio Marioni MD, General Surgery,
University Hospital of Pisa and Luca Felicioni MD, Grosseto Misericordia Hospital)
in collaboration with Carlo De Nisco PhD (Santa Lucia Hospital of Nuoro—
Sardinia) started the robot-assisted experience about 1 year ago (2017) and the
interventions performed so far with robot-assisted technique have shown a shorter
hospital clinical course, with less acute postoperative pain, even if the results in
terms of postoperative recurrence given the short post-surgical follow-up cannot be
assessed yet.
17.5 Conclusions
HTA has shown to be a good decision-making tool, which can allow to achieve the
best results in investments for high cost technologies, as surgical robot. However,
for the evaluation of everyday devices, as sutures or meshes, the use of registries,
combined with HTA, could be more suitable. The Tuscany case shows that an
V. Beretta et al.
197
important change is ongoing: surgeons and institution (NHS) have joined forces to
nd the best solution both from the side of science and of economy. This opens a
window to the future, in order to pass from opposing elds to a system of coopera-
tion with the same aim: a safe surgery.
References
1. Gutt CN, Oniu T, Mehrabi A, Kash A, Schemmer P, Büchler MW.Robot-assisted abdominal
surgery. Br J Surg. 2004;91(11):1390–7.
2. Monson JR.Advanced techniques in abdominal surgery. BMJ. 1993;307(November):1346–50.
3. Hanly EJ, Talamini MA.Robotic abdominal surgery. Am J Surg. 2004;188(4 Suppl. 1):19–26.
4. Armijo PR, Pagkratis S, Boilesen E, Tanner T, Oleynikov D.Growth in robotic-assisted proce-
dures is from conversion of laparoscopic procedures and not from open surgeons’ conversion:
a study of trends and costs. Surg Endosc. 2018;32(4):2106–13.
5. Jefferson T, Abraha I, Chiarolla E, Corio M, Paone S, Piccoli M, etal. HTA report robotic
surgery. Vol. Agenas, Ro. 2017.
6. Hanly EJ, Zand J, Bachman SL, Marohn MR, Talamini MA.Value of the SAGES Learning
Center in introducing new technology. Surg Endosc Other Interv Tech. 2005;19(4):477–83.
7. D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, et al. Robotic
and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum.
2004;47(12):2162–8.
8. Jain S, Jain M.Comparison between laparoscopic and open hernia repair: a clinical trial. Int J
Adv Multidiscip Res. 2018;5(4):1–5.
9. Kuhry E, Van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ. Open or
endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc.
2007;21(2):161–6.
10. Smink DS, Paquette IM, Finlayson SRG.Utilization of laparoscopic and open inguinal hernia
repair: a population-based analysis. J Laparoendosc Adv Surg Tech. 2009;19(6):745–8.
11. McCormack K, Scott N, Go PM, Ross SJ, Grant A.Laparoscopic techniques versus open
techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;1:CD001785.
12. Khajanchee YS, Kenyon TAG, Hansen PD, Swanström LL.Economic evaluation of laparo-
scopic and open inguinal herniorrhaphies: the effect of cost-containment measures and internal
hospital policy decisions on costs and charges. Hernia. 2004;8(3):196–202.
13. Jacobs VR, Morrison JE Jr. Comparison of institutional costs for laparoscopic preperitoneal
inguinal hernia versus open repair and its reimbursement in an ambulatory surgery center. Surg
Laparosc Endosc Percutaneous Tech. 2008;18(1):70–4.
14. Payne JH, Grininger LM, Izawa MT, Podoll EF, Lindahl PJ, Balfour J.Laparoscopic or open
inguinal herniorrhaphy?: a randomized prospective trial. Arch Surg. 1994;129(9):973–81.
15. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G.Prospective comparison of radical
retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology
Institute experience. Urology. 2002;60(5):864–8.
16. Tan A, Ashraan H, Scott AJ, Mason SE, Harling L, Athanasiou T, etal. Robotic surgery: dis-
ruptive innovation or unfullled promise? A systematic review and meta-analysis of the rst
30 years. Surg Endosc. 2016;30(10):4330–52. https://doi.org/10.1007/s00464-016-4752-x.
17. Roh HF, Nam SH, Kim JM.Robot-assisted laparoscopic surgery versus conventional laparo-
scopic surgery in randomized controlled trials: A systematic review and meta-analysis. PLoS
One. 2018;13:1–12.
18. Goodman CS.Introduction to health technology assessment. 2014.
19. National Academy of Engineering C on PEP.A Study of Technology Assessment. 1969.
20. Galbraith JK.The New Industrial State. Princeton: Princeton University Press; 1977. 577p
21. Brooks H, Bowers R.The assessment of technology. Sci Am. 1970;222:13–21.
17 Health Technology Assessment inAbdominal Wall Surgery
198
22. Banta D, Jonsson E. History of HTA: introduction. Int J Technol Assess Health Care.
2009;25(Suppl.S1):1–6.
23. Sorenson C, Chalkidou K. Reections on the evolution of health technology assessment in
Europe. Heal Econ Policy Law. 2012;7(1):25–45.
24. Oliver A, Mossialos E, Robinson R.Health technology assessment and its inuence on health-
care priority setting. Int J Technol Assess Health Care. 2004;20(1):1–10.
25. Banta D, Jonsson E. History of HTA: introduction. Int J Technol Assess Health Care
[Internet]. 2009;25(S1):1–6. Available from: http://www.journals.cambridge.org/
abstract_S0266462309090321.
26. Bero L, Rennie D. The cochrane collaboration: preparing, maintaining, and disseminating
systematic reviews of the effects of health care. JAMA. 1995;274(24):1935–8.
27. Stevens A, Milne R, Burls A.Health technology assessment: history and demand. J Public
Health. 2003;25(2):98–101.
28. Department of Health L.Assessing the effects of health technologies. London: Department of
Health; 1991.
29. Ballantyne GH. Telerobotic gastrointestinal surgery: phase 2—safety and efcacy. Surg
Endosc. 2007;21(7):1054–62.
30. Taylor GW, Jayne DG.Robotic applications in abdominal surgery: their limitations and future
developments. Int J Med Robot Comput Assist Surg. 2007;3(1):3–9.
31. Schumpelick V.In: Schumpelick V, editor. Narbenhernie. Stuttgart: Hernien Thieme; 2000.
p.266–9.
32. Chevrel JP, Rath AM. Classication of incisional hernias of the abdominal wall. Hernia.
2000;4(1):7–11.
33. Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, etal. Classication
and surgical treatment of incisional hernia. Langenbeck’s Arch Surg. 2001;386(1):65–73.
34. Dietz UA, Hamelmann W, Winkler MS, Debus ES, Malafaia O, Czeczko NG, etal. An alter-
native classication of incisional hernias enlisting morphology, body type and risk factors in
the assessment of prognosis and tailoring of surgical technique. J Plast Reconstr Aesthet Surg.
2007;60(4):383–8.
35. Ammaturo C, Bassi G.The ratio between anterior abdominal wall surface/wall defect surface:
a new parameter to classify abdominal incisional hernias. Hernia. 2005;9(4):316–21.
36. Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, etal. The
European hernia society groin hernia classication: simple and easy to remember. Hernia.
2007;11(2):113–6.
37. Muysoms F, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al.
Classication of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407–14.
V. Beretta et al.
Part IV
Future Perspectives