Nerve injury during inguinal hernia repairs can be avoided by taking the topographic anatomy of the inguinal nerves into consideration. The most advantageous plane to look for the iliohypogastric and ilioinguinal nerve during posterior neurectomy is on the anterior surface of the quadratus lumborum muscle. For the surgical treatment of severe chronic inguinodynia, especially after posterior open or endoscopic mesh repair (TAPP/TEP), the retroperitoneoscopic or open retroperitoneal approach for posterior triple neurectomy can be considered.

The MILOS technique allows minimally invasive transhernial repair of incisional hernias using large retromuscular/preperitoneal meshes with low morbidity. The technique combines the advantages of open sublay and the laparoscopic IPOM repair.ClinicalTrials.gov Identifier NCT03133000.

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Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information

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