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We read with interest this report [1] of Petersen's hernia (PH) after mini (one anastomosis) gastric bypass (MGB/OAGB) published recently in your esteemed journal. Authors of this article suggested that surgeons reconsider whether this case report should lead to a recommendation of routine closure of Petersen's space with MGB/OAGB. This issue was hence debated at length within the community of surgeons routinely performing this operation and we feel obliged to share some of the discussion with your readers, who would have also read this case report. First of all, we would like to thank the authors for bringing this problem to our attention. It is indeed a serious issue that merits careful consideration. To the best of our knowledge there is only one other case report of PH after MGB/OAGB [2]. This is significant as there are now several thousand published cases [3,4] of this procedure. Moreover signatories of this letter are now aware of 4 more unpublished cases of PH after MGB/OAGB. Since we believe globally more than 30,000 of this procedure have been carried out till date, this translates into a rough incidence of 2/10,000 published cases and 6/30,000 published as well as unpublished cases. It would hence appear that the incidence of PH is approximately 1:5000. This relatively low incidence might explain why none of the large series till date have reported any PH with MGB/OAGB [3,4]. Authors believe that a long pouch and large Petersen's space with MGB/OAGB helps reduce the incidence of PH with MGB/OAGB. Because it is such a rare condition, we do not believe routine closure of Petersen's space with MGB/OAGB can be recommended at this stage. Moreover the closure may have problems of its own. When surgeons close Petersen's space with Roux-en-Y gastric bypass (RYGB), typically they close the lower part of the space and the space between the Roux limb and the bypassed stomach is left open. Such a closure may actually enhance the incidence of PH with MGB/OAGB by making the space smaller. This might even lead to massive gut infarctions that has not yet been reported after MGB/OAGB but is not unknown after RYGB. In addition, the closure may also predispose to kinks and even leaks;

Background We performed a historical review of events concerning retromuscular hernia repairs over the last two centuries. This may shed light on surgical innovators and their novel techniques that have evolved into current practices. Methods Literature reviews of notable surgeons in the subspecialty were reviewed. Historical context was obtained by personal communication with contemporary surgeons who witnessed changes in established techniques firsthand. Results Even though retromuscular repairs are the central theme of this exercise, it is important to note several adjacent events which steered surgical progress. The status of hernia surgery today is the result of the work of several pioneers separated by time and distance. Conclusions It may be important to understand the circumstances that have propelled past surgical breakthroughs to stimulate future progress.

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Background The use of acronyms in medicine is widespread, aiming to simplify and condense communication. Online communication in social media platforms seems to enhance the use of acronyms, but their efficiency in message delivery may be negated by their abundance and unfamiliarity, causing more confusion than clarity. We analyzed the use of acronyms in a closed Facebook group dedicated to abdominal wall reconstruction (AWR), as the rapid recent development of this field has resulted in many new acronyms. Our aim was to classify the different acronyms and create a public reference. Methods The International Hernia Collaboration, a hernia-related Facebook group, now communicating more than 7500 surgeons from 99 countries, was studied, by extracting acronyms used since its inception in 2012. Acronyms were categorized and interpreted, to create a small dictionary comprised of several tables. Results Commonly used acronyms were identified, as well as commonly used prefixes that modify the acronyms' meaning. Tables were created, classifying acronyms by their subject:1. Anatomy 2. Diseases and clinical conditions 3. Techniques and materials. ConclusionThe use of acronyms increased in social media-based communication. Aiming to simplify the language, the inflation of terms may have achieved the opposite, by adding a multitude of unfamiliar and confusing terms. We have created a public reference for AWR-related acronyms. Limiting the liberal creation of new acronyms is recommended, especially in a rapidly changing field as AWR.

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