Innovation in diagnosis and treatment concepts and technologies for abdominal wall incision hernia

The Guidelines for Diagnosis and Treatment of Abdominal Wall Incision Hernia (2024 Edition) (hereinafter referred to as the Incisional Hernia Guidelines) promotes abdominal wall function reconstruction based on the evidence evaluation criteria of the Oxford University Evidence‑Based Medicine Center, proposes three innovations: (1) Three‑dimensional suturing. Laparoscopic continuous suturing with barbed or quill sutures to close defects, reducing recurrence rates of medium‑to‑large hernias to <8%. (2) Conversion therapy. For giant incision hernia with abdominal wall insufficiency (hernia sac volume ratio >20%), botulinum toxin injection combined with progressive pneumoperitoneum can overcome surgical contraindications, results in increasing defect closure rates by 40% with <5% risk of postoperative abdominal compartment syndrome. (3) Complex abdominal wall evaluation. Evaluates complexity across four dimensions, including systemic factors, abdominal wall related factors, surgical site related factors, and hernia related factors, and individualized intervention is carried out through multidisciplinary teams and hybrid surgery. The Incisional Hernia Guidelines establish a hernia sac volume ratio of 20% as the threshold for loss of abdominal domain, marking the entry of hernia and abdominal wall surgery into an anatomy-function integration era. Based on the innovative points of the "Incisional Hernia Guidelines", the author elaborates on the diagnostic and treatment concepts and technological innovations of abdo-minal incisional hernia, focusing on the technical points of three-dimensional suturing, the imple-mentation of conversion therapy strategies, and individualized treatment of complex abdominal wall evaluation, with the aim of promoting its clinical application and guiding clinical practice.