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Vol. 101. Núm. S1.
Cirugia mínimamente invasiva de pared abdominal
Páginas S19-S23 (mayo 2023)
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Vol. 101. Núm. S1.
Cirugia mínimamente invasiva de pared abdominal
Páginas S19-S23 (mayo 2023)
Special article
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Are abbreviations and acronyms to describe hernia repair techniques overused and helpful? A proposal for rationalisation
¿Las abreviaturas y siglas que describen las técnicas de reparación de hernia se utilizan en exceso y son útiles? Una propuesta de racionalización
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Filip Muysoms
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filip.muysoms@gmail.com

Corresponding author.
, Maaike Vierstraete
AZ Maria Middelares, Ghent, Belgium
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Tablas (8)
Table 1. A list of abbreviations or acronyms used in relation to abdominal wall surgery, but we do realise that many abbreviations or acronyms that also have been used are not included.
Table 2. Proposed letters (lower case) to indicate the surgical approach.
Table 3. Proposed letters (uppercase) to indicate the hernia type.
Table 4. Proposed letters (uppercase) to indicate the mesh position.
Table 5. Proposed letters (uppercase with lowercase) to indicate the mesh type and separate absorbable versus permanent.
Table 6. Proposed letters (uppercase with lowercase) to indicate the fixation type and to separate absorbable versus permanent.
Table 7. Overall proposal for rational use of abbreviations to describe hernia repair techniques.
Table 8. Examples of using the proposed rational use of abbreviations for commonly used acronyms of surgical hernia repair techniques.
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Vol. 101. Núm S1

Cirugia mínimamente invasiva de pared abdominal

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Abstract

Surgeons use abbreviations and acronyms frequently to describe surgical techniques. Recent advances and innovations in repair of abdominal wall hernias, have given rise to a plenitude of novel acronyms. For each small deviation of an existing technique authors have proposed a novel acronym. Since an acronym is most of times not self-explaining it is often hard to understand literature, lectures, symposia programs and discussions in social media. Regularly, we discover different acronyms used for the same procedure and sometimes the same or similar acronyms are used for different techniques. A clear and non-ambivalent description of surgical techniques in the literature is most valuable to summarize scientific evidence in systematic reviews and meta-analyses.

We would like to propose a more rational use of abbreviations to describe hernia repair techniques based on the type of access, type of hernia, mesh position, type of mesh used and type of mesh fixation.

Keywords:
Hernia
Acronyms
Surgical technique
Mesh
Surgery
Abdominal wall
Resumen

Los cirujanos utilizan con frecuencia abreviaturas y acrónimos para describir las técnicas quirúrgicas. Los recientes avances e innovaciones en la reparación de las hernias de la pared abdominal han dado lugar a una plétora de novedosas siglas. Para cada pequeña desviación de una técnica existente los autores han propuesto un nuevo acrónimo. Dado que un acrónimo la mayoría de las veces no se explica por sí mismo, a menudo es difícil de entender la literatura, las conferencias, los programas de simposios y los debates en las redes sociales. Regularmente descubrimos que se utilizan diferentes acrónimos para el mismo procedimiento y, a veces, se utilizan acrónimos iguales o similares para diferentes técnicas. Una descripción clara y sin ambivalencias de las distintas técnicas quirúrgicas que podemos encontrar en la literatura es muy valiosa para resumir la evidencia científica en revisiones sistemáticas y metaanálisis.

El objetivo del presente escrito es proponer un uso más racional de las abreviaturas para describir las técnicas de reparación de las hernias en función del tipo de acceso, el tipo de hernia, la posición de la malla, el tipo de malla utilizada y el tipo de fijación de la misma.

Palabras clave:
Hernia
Acrónimos
Técnica quirúrgica
Malla
Cirugía
Pared abdominal
Texto completo
Introduction

Surgeons use abbreviations and acronyms frequently to describe surgical techniques. The recent advances and innovations in repair of abdominal wall hernias, have given rise to a plenitude of novel acronyms. For each small deviation of an existing technique authors have proposed a novel acronym. Since an acronym is most of times not self-explaining it is often hard to understand literature, lectures, symposia programs and discussions in social media. Regularly, we discover different acronyms being used for the same procedure and sometimes the same or similar acronyms are used for different techniques. A clear and non-ambivalent description of surgical techniques in the literature is most valuable to summarize scientific evidence in systematic reviews and meta-analyses.

We would like to propose a more rational use of abbreviations to describe hernia repair techniques based on the type of access, the type of hernia, the mesh position, the type of mesh used and the type of mesh fixation.

Current state of the acronyms and eponyms in hernia repair techniques

With a search on which acronyms are being used we want to summarize the current status and the foundation why a proposal for rationalisation is important. We show the results in Table 1 but we do realise that many abbreviations or acronyms that also have been used might not have been included.

Table 1.

A list of abbreviations or acronyms used in relation to abdominal wall surgery, but we do realise that many abbreviations or acronyms that also have been used are not included.

Abbreviations and acronyms used in abdominal wall surgery
A
AAW  Anterior Abdominal wall 
ACS  Anterior Component Separation 
ALT  Antero-Lateral Thigh flap 
ARS  Anterior Rectus Sheath 
ASIS  Anterior Superior Iliac Spine 
AWH  Abdominal Wall Hernia 
AWHR  Abdominal Wall Hernia Repair 
AWR  Abdominal Wall Reconstruction 
B
BTA/BTX  Botulinum Toxin A 
BTOM  Bilateral TAPP or TEP with One Mesh 
C
CAWR  Complex Abdominal Wall Reconstruction 
CCS  Carolinas Comfort Scale 
CMF  Central Mesh Failure/Fracture 
CPIP  Chronic Postoperative Inguinal Pain 
CPP  Chronic Pelvic Pain 
CS(T)  Component Separation (Technique) 
cvMPO  critical view of MyoPectineal Orifice 
D
DIEP  Deep Inferior Epigastric Perforator Flap 
DMT  Dermatome Mapping Test 
DMC  Dermatome Mapping Classification 
DOMA  Dermatoscopic Onlay Mesh Augmentation 
DR  Diastasis Recti 
E
‘e’  extended or enhanced 
eLIRA  endoscopic Laparoscopic Intracorporeal Rectus Aponeuroplasty 
eMILOS  endoscopic Mini- or Less Open Sublay repair 
eTEP  extended/enhanced-view Totally ExtraPeritoneal 
EAF  Entero Atmospheric Fistula 
ECF  EnteroCutaneous Fistula 
ECS  Endoscopic Component Separation 
ELAR  Endoscopic Linea Alba Reconstruction 
EO  External Oblique 
ePTFE  extended PolyTetraFluoroEthylene 
F
FG  Fibrin Glue 
G
GPRVS  Giant Prosthetic Reinforcement of the Visceral Sac 
GFN  Genito Femoral Nerve 
H
‘h’  Hybrid 
HH  Hiatal Hernia 
HWPP  Heavy Weight PolyPropylene 
I
IH  Incisional Hernia/Inguinal Hernia/IlioHypogastric nerve 
IHN  Ilio Hypogastric Nerve 
IIN  Ilio Inguinal Nerve 
IO  Internal Oblique muscle 
IPOM (+/plus)  IntraPeritoneal Onlay Mesh (hernia defect closure) 
IRD  Inter Rectus Distance 
J
K
L
‘l’  laparoscopic 
LFCN  Lateral Femoral Cutaneous Nerve 
LIH  Lichtenstein Inguinal Hernia repair 
LIRA  Laparoscopic Intracorporeal Rectus Aponeuroplasty 
LOD  Loss Of Domain 
LTA mesh  Long-Term Absorbable mesh 
LVHR  Laparoscopic Ventral Hernia Repair 
LWPP  LightWeight PolyPropylene 
M
MILA  Minimally Invasive Laparotomy Approach 
MILOS  MIni- or Less Open Sublay repair 
MINIM  Minimally Invasive Non-Intraperitoneal Mesh 
MOMI  Mesh Out Mesh In 
MPO  MyoPectineal Orifice 
N
NPWT  Negative Pressure Wound Therapy 
NVBs  NeuroVascular Bundles 
O
‘o’  open 
OAT  Open Abdomen Treatment 
OPUPS  Open Peri Umbilical Perforator Sparing 
P
PCOM  Primary Closure with Onlay Mesh 
PCS  Posterior Component Separation 
PDS  PolyDioxanone Suture 
PEH  ParaEsophageal Hernia 
PEST  Prostatectomy Extraction Site Trocar hernia 
PIPOM  Partial Intra-Peritoneal Onlay Mesh 
PIPS  Pubic Inguinal Pain Syndrome 
PO  POlyester 
POChP  PostOperative Chronic Pain 
POCIP  PostOperative Chronic Inguinal Pain 
POUR  PostOperative Urinary Retention 
PP  PolyPropylene 
PPAWI  Post-Partum Abdominal Wall Insufficiency 
PPHR  PrePeritoneal Hernia Repair 
PPHR  Pauli Parastomal Hernia Repair 
PPP  Pauli Parastomal Plasty/Progressive PneumoPeritoneum 
PROM  Patient Reported Outcome Measures 
PRS  Posterior Rectus Sheath 
PTS  Progressive Tension Sutures 
PVDF  PolyVinyliDene Fluoride 
PUMP  Preperitoneal Umbilical hernia Mesh Plasty 
PUPS  PeriUmbilical Perforator-Sparing component separation 
Q
R
RALS  Robot-Assisted Laparoscopic Surgery 
RA-LVHR  Robot-Assisted Laparoscopic Ventral Hernia Repair 
RASD  Robotic Assisted Surgical Devices 
REPA  Reparación Endoscopica PreApeurotica 
R-IPT  Robotic IlioPubic Tract repair 
RoboTAR  Robotic Transversus Abdominis Release 
RoME  Robotic Mesh Excision/Explantation 
RR  RetroRectus 
RS  Rives-Stoppa 
RS  Retention Sutures 
rTAPP  robot-assisted TransAbdominal PrePeritoneal 
rTAR  robot-assisted Transversus Abominis Release 
rTARUP  robotic Trans-Abdominal Retromuscular Umbilical Prosthetic repair 
rTMR  robotic Transabdominal Midline Reconstruction 
S
SBO  Small Bowel Obstruction 
SBR  Small Bowel Resection 
SC  Spermatic Cord/SubCutaneous 
SCOLA  SubCutaneous Onlay Laparoscopic Approach 
SIRRS  Single Incision RetroRectus Surgery 
SMART  Stapled Mesh stomA Reinforcement Technique 
SMAS  Subcutaneous MusculoAponeurotic System aka Scarpa's and Camper's fascia 
SSE  Surgical Site Event 
SSI  Surgical Site Infection 
SSO  Surgical Site Occurrence 
SSOPI  Surgical Site Occurrences requiring Procedural Interventions 
STORM  Stapled Transabdominal Ostomy Reinforcement with Mesh 
STORRM  Stapled Transabdominal Ostomy Reinforcement with (Retromuscular) Mesh 
SUPERSEXI repair  SUpraPubic Endoscopic Repair with Synthetic EXtraperitoneal Implant repair 
T
TA  Transversus Abdominis muscle 
TAMR  TransAbdominal Midline Reconstruction 
TAP  Transversus Abdominis Plane 
TAPE  TransAbdominal Partial Extraperitoneal 
TAPP  TransAbdominal PrePeritoneal 
TAR  Transversus Abdominis Release 
TARM  TransAbdominal RetroMuscular repair 
TARUP  TransAbdominal Retromuscular Umbilical Prosthetic repair 
TASDRR  TransAbdominal Single Dock RetroRectus 
TEP  Totally Extraperitoneal Prosthesis 
TESLAR  Totally Endoscopic Supra-aponeurotic Linea Alba Reconstruction 
TIPP  TransInguinal PrePeritoneal 
TMR  Transabdominal Midline Reconstruction 
TRAM  Transverse Rectus Abdominis Myocutaneous flap 
TRUMP  Transabdominal RetroUMbilical Prosthesis 
U
V
VAS  Visual Analogue Scale 
vTEP  ventral Totally Extraperioneal Prosthesis 
VH  Ventral Hernia 
VHR  Ventral Hernia Repair 
W
WLS  Weight Loss Surgery 
WWYD  What Would You Do 
X
Y
Z
Proposal for a rational use of abbreviationsSurgical approach

We propose to use a lowercase letter to indicate the approach used. This is regularly used to indicate a robotic approach (r-TAPP). We propose to use the same for other approaches. Open surgery is a repair performed via an open incision in the skin. Laparoscopic surgery is an endoscopic approach involving the creation of a pneumoperitoneum, which is often also named trans-abdominal approach (TAPP, TARUP, TARM). An extraperitoneal approach is an endoscopic approach where the goal is to avoid creating a pneumoperitoneum and to stay extraperitoneal to perform the repair (TEP, eTEP). A hybrid procedure is an endoscopic procedure with a planned open procedural step where a skin incision is made to perform part of the surgery via this incision. A hybrid approach is different from a conversion, where the surgery is moved from an endoscopic approach to an open approach because of an intraoperative change of plan caused by surgical difficulties or complications. All the endoscopic approaches can be performed using a robotic platform and are than called robot assisted endoscopic surgeries. A proposal for the lower-case letter(s) to be used for each approach is given in Table 2. We also propose the lowercase letter indicating the surgical approach to be followed by a hyphen to set it apart from the main abbreviations on hernia type, mesh type, mesh position and mesh fixation.

Table 2.

Proposed letters (lower case) to indicate the surgical approach.

Surgical approach
o-  open 
l-  laparoscopic 
e-  extraperitoneal 
h-  hybrid 
rl-  robotic laparoscopic 
re-  robotic extraperitoneal 
rh-  robotic hybrid 
Hernia type

Groin hernia is a collection of lateral inguinal hernias, medial inguinal hernias, and femoral hernias. For the description of these group of cases we propose to use the letter G. Groin hernias are classified according to the European Hernia Society (EHS) classification in lateral (L), medial (M) and femoral (F) hernias, with the size of the hernia defect described as size 1, 2 or 3.1

Primary ventral hernias are described by the EHS as umbilical, epigastric, spigelian and lumbar hernias. We propose to use U, E, S and L.2 Secondary ventral hernias are mostly incisional hernias and we propose to use I. Some studies combine primary and secondary ventral hernias, for which we propose to use the letter V. Primary ventral hernias are classified by the EHS classification according to the type and the size of the hernia (small <2cm; medium 2–4cm; large >4cm). Incisional ventral hernias are classified by the EHS classification according to the location of the hernia (medial zones M1–M5; lateral zones L1–L4) and the width of the hernia (W1 <4cm; W2=4–10cm; W3 >10cm).

Parastomal hernias are classified according to the EHS classification according to the size and presence of a concomitant incisional hernia (Type I to Type IV) (Table 3).3

Table 3.

Proposed letters (uppercase) to indicate the hernia type.

Hernia type
G  Groin 
U  Umbilical 
E  Epigastric 
S  Spigelian 
L  Lumbar 
V  Ventral 
I  Incisional 
P  Parastomal 
Mesh position

Meshes can be implanted in different layers of the abdominal wall during hernia repair. A consensus on mesh position terminology has been described recently and is proposed using the first letter of the abdominal wall plane. If no mesh was placed, we propose to use X. Four planes are described: Onlay (O), Retrorectus/Retromuscular (R), Preperitoneal (P) and Intraperitoneal (I) (Table 4).

Table 4.

Proposed letters (uppercase) to indicate the mesh position.

Mesh position
X  no mesh 
O  Onlay 
R  Retrorectus-Retromuscular 
P  Preperitoneal 
I  Intraperitoneal 
Mesh type

For hernia repair without the use of a mesh we propose the letter X. Meshes can be divided based on their origin (synthetic versus biological) and whether they are permanent or will absorb over time. Moreover, some combinations of partially absorbable meshes do exist. We propose the letters S and B for synthetic and biologic mesh respectively as an uppercase added by a lowercase p or a, to indicate permanent or absorbable meshes (Table 5).

Table 5.

Proposed letters (uppercase with lowercase) to indicate the mesh type and separate absorbable versus permanent.

Mesh type
X  no mesh 
Sp  Synthetic permanent 
Sa  Synthetic absorbable 
Ba  Biological absorbable 
Mesh fixation

Meshes can be either not fixed, fixed with sutures, fixed with glue or fixed with tackers. The tackers can be either permanent or absorbable (Table 6).

Table 6.

Proposed letters (uppercase with lowercase) to indicate the fixation type and to separate absorbable versus permanent.

Mesh fixation
X  no fixation 
A  Autofixating 
S  Sutures 
G  Glue 
Tp  Tackers permanent 
Ta  Tackers absorbable 
Summary

In Table 7 we present an overview of the proposal and in Table 8 we list some examples of using the proposal for commonly used hernia repair techniques.

Table 7.

Overall proposal for rational use of abbreviations to describe hernia repair techniques.

Surgical approachHernia typeMesh positionMesh typeMesh fixation
o-  open  G  Groin  X  no mesh  X  no mesh  X  no fixation 
l-  laparoscopic  U  Umbilical  O  Onlay  Sp  Synthetic permanent  A  Autofixating 
e-  extraperitoneal  E  Epigastric  R  Retrorectus-Retromuscular  Ba  Biological absorbable  S  Sutures 
h-  hybrid  S  Spigelian  P  Preperitoneal  Sa  Synthetic absorbable  G  Glue 
rl-  robotic laparoscopic  L  Lumbar  I  Intraperitoneal      Tp  Tackers permanent 
re-  robotic extraperitoneal  V  Ventral          Ta  Tackers absorbable 
rh-  Robotic hybrid  I  Incisional             
    P  Parastomal             
Table 8.

Examples of using the proposed rational use of abbreviations for commonly used acronyms of surgical hernia repair techniques.

Operative technique  abbreviation 
TAPP groin with mesh and glue  l-GPSpG 
rTARUP with mesh and suture fixation  rl-URSpS 
IPOM incisional hernias with absorbable tackers  l-IISpTa 
LIRA incisional hernia with permanent tackers  l-IISpTp 
eTEP epigastric hernia with self-fixating mesh  e-ERSpA 
Lichtenstein repair  o-GRSpS 
Schouldice  o-GXXX 
open PPHR Pauli Parastomal Hernia Repair without fixation  o-PRSpX 
Conclusion

A plenitude of acronyms is currently used to describe surgical advances in hernia surgery. To overcome ambiguity in reporting scientific literature, we propose a more rational use of abbreviations to describe hernia repair techniques based on the type of access, the type of hernia, the mesh position, the type of mesh used, and the type of mesh fixation.

Funding

None declared.

Conflict of interest

FM reports having received research grants from Medtronic, Intuitive Surgical and FEG Textiltechnik besides speakers’ honoraria from Medtronic, BD Bard, Intuitive Surgical and WL GORE, consultancy honoraria from Medtronic, CMR surgical and expert testimony from Sofradim. FM is proctor for Intuitive Surgical and participates in the Advisory Board of Medtronic.

MV reports participation in the Advisory Board of Medtronic.

References
[1]
M. Miserez, J.H. Alexandre, G. Campanelli, F. Corcione, D. Cuccurullo, M.H. Pascual, et al.
The European hernia society groin hernia classification: simple and easy to remember.
Hernia, 11 (2007), pp. 113-116
[2]
F.E. Muysoms, M. Miserez, F. Berrevoet, G. Campanelli, G.G. Champault, E. Chelala, et al.
Classification of primary and incisional abdominal wall hernias.
Hernia, 13 (2009), pp. 407-414
[3]
M. Śmietański, M. Szczepkowski, J.A. Alexandre, D. Berger, K. Bury, J. Conze, et al.
European Hernia Society classification of parastomal hernias.
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