10 Mar 2024 Trilogy – Reflections from the AWR Europe 2024
Trilogy – Reflections from the Abdominal Wall Reconstruction Europe 2024 (AWRE)
In this second entry of the trilogy, I will talk about the Abdominal Wall Reconstruction Europe (AWRE). AWRE is one of the most important conferences on abdominal wall and hernia surgery in the European continent. It is held annually, usually in February. The organisation’s leaders are general surgeon Alistar Windsor and plastic surgeon David Ross from London. While it is usually held in London every year, this year they came to the mainland, and the 9th AWR Europe took place in Ghent, Belgium. I had the opportunity to attend as an invited speaker for the first time, marking my 7th visit to Ghent. I regretted not having been there before. Why? Firstly, because it focuses on incisional hernias, which are the most problematic area of hernia surgery, in my opinion. There’s hardly any mention of groin hernias. Secondly, they feature highly experienced, world renowned speakers in the scientific program. New names are added each time, and you get to see different experiences. Only then can you grasp the nuances, which positively contribute to your daily practice.
Al and David are close friends who run this event very successfully. The ample time allocated for discussions after presentations and the interactive sessions are very impressive. I sincerely congratulate them.
When it comes to hernia surgery, especially abdominal wall reconstruction, Todd Heniford is undoubtedly the biggest name! He needs no introduction. He also participated as a speaker. As far as I know, he has been a speaker at most of the previous events. Listening to him every time is a great pleasure and very impactful. Always learn much from him. His speeches are inspiring. He performs very well on stage. He’s also a great friend. I am proud to know him personally.
Another big name – they are all big, but it would take a book if I were to write about them all – is Yohann Renard. Yohann is from Reims, France. He is currently the head of John Rives’ clinic. What a great honor. Yohann more than lives up to this at a young age. He is also an anatomist. In conferences and hernia courses, he explains abdominal wall and groin anatomy by drawing on a board with chalk. Not only anatomy but also surgical techniques! He has tremendous artistic talent. You must definitely watch him. He makes complex abdominal wall anatomy so understandable that it’s impossible not to admire. He and his clinic have deep experience in complex abdominal wall surgery repairs. EHS members visit his clinic with EHS travel grants. Yohann is also one of the main actors in EHS cadaver courses. Yohann is not from this planet!
I spoke about laparoscopic ventral hernia repairs in the main program. There are many new techniques from IPOM to eTEP, and lately, the popularized ventral TAPP and SCOLA techniques. As they say, ‘Many Ways to Skin a Cat’, there is no one-size-fits-all approach. You should apply the most suitable surgical approach for each case. Tailoring to the individual! So, the decision-making process is complex; it requires deep knowledge and experience. This is what makes hernia surgery attractive, in my opinion. It is always open to development, and new techniques are emerging. We see different interpretations and applications at conferences. It’s truly inspiring. My friend Miguel Ángel García Ureña from the Madrid Group was also at the conference. He has a very nice saying: as your knowledge deepens in abdominal wall anatomy, there is still room to find new techniques. How true!!
In my second talk, sponsored by Gore, I presented a talk titled ‘Why do we still question IPOM?’ In a way, I defended IPOM. Recently, some well-known hernia surgeons have been arguing against placing meshes inside the abdomen and have gained followers. Unfortunately, there is no scientific evidence for this. IPOM is now 30 years old and established, proven to have good results, an ‘old’ technique. Now it’s trying to be buried. Frederik Helgstrand, current president of the Danish Hernia Society, has a nice saying: ‘25 years ago, LVHR was heavily introduced without evidence and now… LVHR was abandoned without evidence!’ How true! eTEP ventral has been at the forefront as a minimally invasive technique against IPOM. This relatively new technique is gaining popularity. eTEP application is a challenging technique, working in a complex anatomy and a small space. It has potential and significant complications. It requires extensive anatomy knowledge and technical skills. My highlights on this subject were published in July 2023 in the Journal Hernia under the title ‘Achilles of eTEP’. Let me conclude this topic with my words: ‘IPOM for general surgeons, MIS extraperitoneals for hernia surgeons!’
This meeting was again organized by the Mark Allen Group, as I detailed in the first part of the trilogy. They were very successful again.
We coincided with The Light Festival, held every three years in beautiful Ghent. It is truly an art event that must be seen. Throughout the event, the city witnesses a light show at night. Walking along a route, you see the installations artists have made with light. It’s uplifting!
Next year, AWR Europe will be held in London and will celebrate its 10th year. Don’t miss it!
