Asim Abbas

Purpose: This study aimed to explore how individuals with hernia engage with online peer-support communities and how their shared narratives reflect the experience of living with and seeking treatment for hernia. Methods: A qualitative netnographic approach was employed, analysing posts from a large online hernia support group with approximately 8,500 members across more than 10 countries. The group was selected following scoping of alternative online communities because of its size, activity, heterogeneity, and public accessibility. A purposive sample of 26 high-engagement discussion threads comprising 936 comments was analysed using Braun and Clarke’s reflexive thematic analysis, involving iterative familiarisation, inductive coding, theme development, and refinement. Saturation was monitored throughout, and data collection concluded when no new dominant themes were identified. Results: Four inductively derived themes were identified: Surgical Experiences and Outcomes, Patient Concerns and Fears, Healthcare System and Access, and Coping and Support. Narratives described mesh-related anxiety, fear of recurrence, mistrust in healthcare providers, structural barriers to care, body-image concerns, and uncertainty surrounding treatment and recovery. Mesh discussions included concerns about safety, long-term complications, and living with an implanted material, alongside positive experiences of mesh repair. Participants also demonstrated active health-information-seeking behaviours, including peer validation, appraisal of surgical options, and self-advocacy. A visual summary of findings is included (see accompanying infographic). Conclusion: Online patient narratives offer rich insight into the lived experience of hernia and demonstrate how peer communities contribute to information seeking, support, and treatment-related discussion. These exploratory findings identify issues relevant to patient-centred communication and future outcomes research and suggest value in recognising the digital patient as an active information-seeker and co-producer of meaning.

Incisional hernia (IH) is a common complication of abdominal surgeries, characterised by the protrusion of abdominal contents through a weakened surgical scar. Despite advancements in surgical techniques and biomaterials, IH remains a significant clinical and economic burden, with recurrence rates reaching up to 32% after repair. This unusually high number, despite many years of research focused on the improvement of surgical techniques, requires a better understanding of the potential origins of IH occurrence. This must implicate the tissues involved in scar formation of the abdominal wall for a better understanding of how these tissues are affected by the incision and what can potentially affect the most optimal wound healing. This work aimed to provide a comprehensive summary of the current knowledge regarding the ultrastructure of the abdominal wall and how incisions affect its mechanical integrity.

Background: Abdominal Wall Hernia (AWH) is a structurally and functionally disruptive condition often assessed through objective clinical variables such as position, size, reducibility, skin changes, and symptoms of obstruction suggesting the need for urgent treatment. However, little attention has been given to explore all the symptoms experienced. Many Health-Related Quality of Life (HRQoL) tools fail to capture the nuances of lived experience, especially around pain, restriction, and behavioural response. This study provides a qualitative examination of the symptomatology and functional impact of AWH as described from the patient’s perspective. Methods: This phenomenological study draws on 15 semi-structured interviews with patients living with AWH. Participants were sampled purposively across a spectrum of hernia complexity (VHWG grades 1–4). Transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to generate superordinate and subordinate themes concerning symptoms and functional impact. Data analysis was triangulated between qualitative and surgical researchers. Results: The analysis revealed a superordinate theme of “Symptoms and Function,” with three distinct but overlapping subordinate domains: management of pain, freedom of movement, and restriction and adaptation. Participants described persistent background pain, episodic sharp exacerbations, and visceral sensations (e.g., bloating and urinary urgency). Anticipatory vigilance shaped movement planning, with participants choreographing basic tasks and progressively surrendering valued activities across both leisure and employment. Restriction triggered inventive adaptations, including custom abdominal binders and adjusted routines. Conclusions: AWH imposes a diffuse, dynamic and difficult burden on patients’ bodies and lives, extending far beyond the anatomical boundaries typically measured in clinical practice. Participants described a constellation of physical symptoms, including pain, visceral discomfort, and movement restriction. Our findings highlight that functional limitation in AWH is a biopsychosocial phenomenon. These experiences resonate with pain-psychology frameworks and demonstrate the limitations of reductionist surgical assessments. Effective interventions must match the complexity of lived experience, combining surgical, psychological, and rehabilitative strategies.

Giant inguinoscrotal hernias (GISHs) are rare and present unique surgical challenges. We report a case of a man in his 60s with a GISH complicated by loss of domain, with nearly two-thirds of the small bowel and right colon incarcerated in the inguinoscrotal hernia sac. A comprehensive preoperative plan was implemented, including botulinum toxin injections, placement of an inferior vena cava filter and progressive preoperative pneumoperitoneum per a locally developed protocol. A combined surgical approach was used, involving laparotomy, scrotal reconstruction, adhesiolysis, right hemicolectomy with omentectomy and Rives-Stoppa mesh repair extending into the retropubic space. A suture closure of the inguinal ligament to the pectineal line was performed with a Phasix Mesh. Plastic surgical techniques were employed to reduce scrotum size and reconstruct the penis. This case demonstrates the importance of a multimodal perioperative and surgical approach to manage GISHs to achieve optimal surgical outcomes.

Abdominal wall hernia (AWH) represents an increasingly prevalent and clinically significant condition, particularly in high-income health systems where surgical volumes for hernia repair continue to rise (1,2), (3). The evaluation of surgical success has gradually expanded beyond recurrence rates and operative morbidity to include outcomes that are more reflective of patient priorities, such as restoration of function and overall quality of life (QoL) (4,5). AWH exerts a broad and often underappreciated impact on patients' lives. Qualitative research has identified interconnected psychosocial, physical, and socioeconomic domains that are adversely affected (6), including body image (7), mental health (8), sexual and social relationships, and employment.In recognition of these complexities, patient-reported outcome measures (PROMs) have gained prominence as essential tools for capturing the subjective burden of AWH and evaluation of surgical intervention, particularly in Complex Abdominal Wall Reconstruction (CAWR) (9,10). Among these, health-related quality of life (HRQoL) assessment tools represent a subset, designed to assess broader impacts of health on physical, psychological, and social functioning. Several instruments have been developed or adapted to quantify domains such as pain, physical limitation, and well-being (4). However, despite increasing uptake in research settings, HRQoL instruments are inconsistently employed in clinical practice, and their interpretive value remains limited (11,12). The predominant approach involves scoring and aggregating responses into numerical indices, overlooking nuanced patient experiences, especially in those with complex biopsychosocial needs (13).Concurrently, artificial intelligence (AI) has demonstrated being a powerful tool in healthcare analytics, offering new capabilities in pattern recognition, data analysis, and predictive analytics. AI refers to digital solutions that simulate cognitive tasks typically requiring human reasoning, including classification, prediction, and pattern recognition. Within this field, machine learning (ML) trains mathematical models to learn from data or past experience in order to make decisions or predictions, while natural language processing (NLP) enables computer algorithms to interpret and analyse human language (14). In surgical disciplines, AI offers an opportunity to enhance diagnostic imaging, intraoperative decision support, and postoperative risk stratification (15). More recently, attention has turned to AI's role in the analysis of PROMs and HRQoL tools, particularly through NLP and ML (16). In fields such as oncology and orthopaedics, AI is being explored as a potential avenue to enable deeper exploration of patient-reported data, including through the use of free-text narratives and longitudinal symptom trajectories, offering insights that traditional statistical approaches often fail to capture (17,18). This presents a timely opportunity for hernia surgery.This paper is positioned as an "Opinion" article, offering a conceptual perspective on how AI could enhance the utility of HRQoL assessment tools in AWH surgery. While existing tools are valuable, their reliance on closed-ended, structured response formats limits their ability to reflect the complexity of patients' lived experiences, particularly in domains such as body image, mental health, and interpersonal relationships. This paper has three main aims: to argue current data collection methods in AWH HRQoL tools insufficiently capture the biopsychosocial dimensions of patient experience; to advocate for a shift toward AI-augmented interpretation, with a particular focus on NLP; and to propose a vision for future research and clinical integration, where HRQoL tools serve as dynamic instruments for personalised care.We support this argument by appraising commonly used AWH HRQoL tools and drawing on other specialties where AI has enriched the analysis of similar data. We conclude with a proposed framework for implementing these approaches.To support the argument that current HRQoL tools in AWH surgery inadequately capture the complexity of patient experience, we appraise data collection methods and response formats employed by commonly used instruments. In a separate literature review (currently in press), we identified six condition-specific HRQoL assessment tools in AWH populations: Carolinas Comfort Scale (CCS) (19), Hernia-Related Quality of Life Survey (HerQLes) (20), European Registry for Abdominal Wall Hernias QoL instrument (EuraHS-QoL) (21), Activities Assessment Scale (AAS) (22), Abdominal Hernia-Q (AHQ) (23), and Hernia-Related Quality of Life instrument (HERQL) (24).Our appraisal focuses on response structures (such as Likert scales and binary items) and whether open-ended responses are permitted. Rather than assessing psychometric validity, we examine how design shapes the type and quality of data collected, and the extent to which it permits expression of meaningful patient perspectives.The structured appraisal presented in Table 1 highlights a unifying feature across HRQoL assessment tools in AWH surgery: a reliance on fixed-response, closed-ended formats that generate exclusively quantitative data. While practical, they are constrained in their capacity to capture the complexity of individual patient experience (25).Quantitative HRQoL assessment tools assume that complex biopsychosocial phenomena can be reduced to single numerical scores (26). Pain is commonly measured on a 0-10 scale, with little or no ability to capture its temporal variability, emotional salience, or relationship to social withdrawal. Similarly, a patient who reports "moderate" difficulty with movement may do so because of mechanical restriction, anxiety about recurrence, or fear of judgment in public. These are qualitatively distinct and clinically relevant.The absence of open-ended input prevents patients from contextualising their responses (27)....

Background: Abdominal Wall Hernia (AWH) impacts interpersonal relationships, which are vital to human wellbeing [1, 2], however social and sexual dimensions of AWH remain underexplored. This study investigates the impact of AWH on social disconnection and sexual intimacy challenges, and how this could be viably assessed in health related quality of life (HRQoL) assessment tools. Methods: A qualitative approach using Interpretative Phenomenological Analysis (IPA) was employed [3]. Fifteen participants (8 men and 7 women, aged 36–85 years) were purposively sampled. Data collected via semi-structured interviews was analysed iteratively until no new themes emerged [4]. Results: AWH significantly impacted participants' interpersonal relationships, mainly through ‘difficulties in connecting socially’ and ‘changes in sexual relationships’. Participants' social withdrawal was driven by physical limitations, altered self-perception, and stigma, leading to loneliness and reduced engagement. Changes in sexual relationships were shaped by pain, body image concerns, and perceived sexual pressure, often diminishing physical intimacy. Despite these challenges, emotional intimacy frequently persisted, largely due to empathetic and supportive partners. Postoperative improvements were highlighted as pivotal in restoring body confidence and intimacy. Conclusions: This study illustrates the profound social and sexual disruptions AWH causes. These effects should be included in holistic and patient centred care, and incorporated into HRQoL assessment tools. Preoperative counselling should include issues of social connection and intimacy, whilst postoperative care should integrate structured support networks, psychoeducational interventions, and psychosexual counselling. Future research should pilot, revise and test the effectiveness of such measures.

Background Health-Related Quality of Life (HRQoL) is increasingly recognized as a key outcome measure in Complex Abdominal Wall Hernia (CAWH) surgery. However, selecting an appropriate HRQoL tool is challenging due to the variety of available instruments and their variable psychometric properties. Aim This scoping review systematically reviews and evaluates the six CAWH-specific HRQoL tools using the Consensus-based Standards for the Selection of Measurement Instruments (COSMIN) framework. The aim of this scoping review was to assess the clinical suitability and developmental robustness of CAWH-specific HRQoL instruments. This review does not assess post-operative HRQoL outcomes, but rather evaluates the design, content, and methodological quality of CAWH-specific tools themselves using the COSMIN framework. Methods A scoping review was conducted in accordance with PRISMA-ScR and informed by COSMIN and Joanna Briggs Institute (JBI) scoping methodology. Four databases (MEDLINE, EMBASE, Cochrane CENTRAL, ClinicalTrials.gov) were searched (March 2024) to identify studies that used or evaluated CAWH-specific HRQoL tools. Tools were assessed across key COSMIN domains: conceptual framework, psychometric properties, respondent burden, and patient involvement in development. Results Six CAWH-specific HRQoL instruments were identified: CCS, HerQLes, EuraHS-QoL, AAS/mAAS, AHQ, and HERQL. While these tools demonstrated utility, none fully integrated patient perspectives from initial domain development, and all exhibited gaps in content and structural validity. Comparative psychometric data across tools were limited, further complicating selection. Conclusion Despite growing interest in measuring HRQoL in CAWH surgery, existing tools show important developmental limitations. While these tools demonstrate utility, none fully integrate patient perspectives throughout their development, and all exhibit gaps in content and structural validity. Additionally, comparative psychometric data remain limited, further complicating tool selection. Given these limitations, there is a clear need for further development—either by refining existing tools or creating a new, patient-informed HRQoL instrument that adheres to robust psychometric standards.

Background: Complex Abdominal Wall Reconstruction (CAWR) in patients with significant loss of domain poses substantial surgical and physiological challenges [1], [2]. Preoperative Progressive Pneumoperitoneum (PPP), involving incremental insufflation of gas into the abdominal cavity, enhances the likelihood of tension-free fascial closure [3]. However, there remains considerable variability and incompleteness in existing PPP protocols, especially concerning venous thromboembolism (VTE) prophylaxis, inferior vena cava (IVC) filter placement, respiratory prehabilitation, and multidisciplinary coordination. Methods: A structured literature review was conducted (MEDLINE® and Embase®, final search April 2025), yielding no comprehensive PPP protocols for CAWR. In response, we convened a multidisciplinary team at a tertiary UK referral centre—including specialists in general surgery, plastic and reconstructive surgery, vascular surgery, interventional radiology, and pharmacy—to develop an integrated, replicable protocol. Consensus development methods (CDMs) informed the iterative refinement process, incorporating clinical experience and best available evidence. Results: Our seven-week perioperative protocol systematically integrates key preoperative interventions: bilateral abdominal wall botulinum toxin injections, respiratory prehabilitation, abdominal binder use, VTE prophylaxis with low molecular weight heparin (LMWH), planned IVC filter insertion, peritoneal dialysis catheter placement, and scheduled PPP insufflation sessions. Final surgical planning is guided by crosssectional imaging obtained one week preoperatively. Postoperatively, a structured IVC filter removal strategy, including cavogram assessment, is implemented to manage thromboembolic risk. Conclusion: We present a comprehensive PPP protocol designed to optimise outcomes in CAWR. This structured, multidisciplinary approach represents an important step toward standardising care in complex abdominal wall reconstruction.