Ventral and Incisional Hernias: A Systematic Review Focusing on Classification and Minimally Invasive Surgical Approaches

Background: Ventral and incisional hernias represent a significant surgical burden worldwide, with complex pathogenesis and evolving management strategies. Accurate classification and appropriate selection of surgical techniques are essential to optimize outcomes and reduce recurrence rates. This systematic review aims to summarize current classification systems and evaluate minimally invasive surgical approaches for ventral and incisional hernias.

Methods: A systematic literature search was carried out in PubMed/MEDLINE, Scopus, and Web of Science from inception to December 2024, following the PRISMA 2020 guidelines. Studies eligible for inclusion consisted of all types of studies, such as randomized controlled trials, cohort studies, and observational studies, according to the classification, pathogenesis, and surgical management of ventral and incisional hernias. Data are qualitatively synthesized due to heterogeneity across studies.

Results: A cumulative total of 30 studies were included in the final qualitative synthesis. Current classification schemes, especially those advocated by the European Hernia Society (EHS), offer an established anatomical/clinical framework for hernia evaluation. Minimally invasive methods, such as the laparoscopic intraperitoneal onlay mesh (IPOM) technique, showed decreased rates of wound complications and hospital stay compared to open surgery, without significantly increasing the recurrence rate in carefully selected patients. Mesh repair, especially retromuscular sublay mesh, continued to be the gold standard for open hernia repair.

Conclusion: There has been an increasing emphasis on the management of ventral and incisional hernias towards an individualized and evidence-based practice of standardized classification systems in conjunction with minimally invasive repair. Patient selection and the optimization of modifiable risk factors play an important role in the achievement of durable repair of hernias.