Purpose: Complex abdominal wall hernias (CAWH) present significant surgical and peri-operative challenges, particularly in populations with high comorbidity burden. Multidisciplinary team (MDT) models have been shown internationally to improve patient optimisation and operative planning, yet Australian data remains limited. This study describes the implementation of a dedicated CAWH MDT in a South Australian hospital and reports preliminary outcomes from its first year. Methodology: A retrospective cohort study was conducted of all patients discussed at the CAWH MDT at the Lyell McEwin Hospital between May 2024 and May 2025. Demographic data, hernia characteristics, comorbidities, MDT recommendations, and operative plans were prospectively recorded. Clinical outcomes were obtained through electronic medical records. For patients undergoing operative repair, concordance between MDT recommendations and operative management was assessed and categorised as full, partial, or non-concordant. Results: 71 patients were discussed across 11 MDT meetings. The mean age was 61.6 years and mean BMI was 37.5 kg/m², with 32.3% of patients having a BMI >40 kg/m². Incisional hernias accounted for 83.1% of cases, and 30.5% had undergone previous mesh repair. Following MDT review, 52 patients (73.2%) were recommended for operative management, while others were directed toward optimisation strategies including weight loss (63.4%), smoking cessation (26.8%), and pre-operative botulinum toxin (46.5%). Seventeen patients proceeded to surgery during the study period. Of these, 10 (58.8%) were fully concordant and three (17.6%) partially concordant with MDT recommendations, yielding an overall concordance rate of 76.4%. Conclusion: Establishing a structured CAWH MDT is feasible in an Australian tertiary setting and achieves high concordance between multidisciplinary planning and operative management. Early experience suggests MDT review supports patient optimisation, consistent decision-making, and safe delivery of complex abdominal wall reconstruction.

Purpose Laparoscopic colorectal procedures require specimen extraction. Our centre’s colorectal surgeons employ midline and off-midline incisions for extraction of surgical specimens. Midline incision for specimen extraction is associated with higher incidence of both surgical site infection (SSI) and Incisional hernia (IH). We sought to assess compare outcomes in off-midline versus midline extraction sites for colorectal resections. Methodology This was a retrospective, single institution, multi-surgeon study for patients undergoing laparoscopic colorectal resection for both malignant and benign pathology from January 2021 to January 2024. Datapoints extracted include patient demographics; risk factors for SSI and IH and operative details. Any cases which were converted to open, returns to theatre or used perineal extraction were excluded. Between extraction site techniques, primary outcome measures being development of SSI or acute dehiscence within 30 days of surgery and development of IH within 12 months of the surgery were examined. Nominal data was compared using the Student’s t-test (parametric) and Wilcoxon test (nonparametric). Ordinal data was compared using the Man-Whitney U test. Non-ordinal categorical data was compared using Pearson’s chi-squared test. Statistical significance was defined as p < 0.05. Results A total of 231(196 elective) were examined. Median age was 67 50% were female, 27% received chemotherapy. Common indications for surgery included colorectal cancer (117) and diverticular disease (76). Extraction techniques included midline (41.5%); left lower quadrant (10.8%) and Pfannenstiel (47.6%). There was a lower SSI incidence in Pfannenstiel compared to midline extraction (2.7% vs 4.1%). There was no incidence of acute dehiscence. There were no IH at 12 months in off-midline, compared to 6 (6.3%) from midline extraction. Survival was similar between cohorts. Conclusion Our preliminary results suggest that off-midline extraction sites have less risk of incisional hernia incidence at 12 months and lower SSI rate.

Background The development of a hernia is a known complication of peritoneal dialysis (PD), and such patients have high rates of hernia surgery. This study evaluated the association between hernia surgery and the primary outcome of transfer to haemodialysis (HD) for >90 days. Methods The study included all patients who started PD in Australia and New Zealand between 2000 and 2015. Using bi-national data linkage between the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets, patients receiving PD who underwent hernia surgery, based on Australian Classification of Health Interventions (ACHI) coding were matched in a 1:3 ratio with those who did not undergo hernia surgery (controls), using propensity score matching based on year of PD start, age, body mass index (BMI), ischaemic heart disease (IHD) and diabetes mellitus (DM). The surgery date for cases was used as a mock index date for potential controls who were alive and at risk at that time, to minimise immortal time bias. Time from surgery or mock index date to HD transfer was analysed by Cox regression with shared frailty to account for centre effect, censored for kidney transplantation, death or end of study (31 December 2021). Results A total 1,433 PD patients underwent hernia surgery. The characteristics of the matched controls when compared to cases were similar in age, PD vintage, BMI, and rates of IHD and DM, however differed in gender proportions (70% male in cases vs. 66% in controls). Cox regression showed that hernia surgery had an increased risk of HD transfer over entire follow up (HR 1.22, 95% CI 1.12 – 1.34). Male gender, vintage, larger BMI and DM were also associated with increased HD transfer risk. Conclusion In patients receiving PD, patients who underwent hernia surgery had increased risk the primary outcome of HD transfer for >90 days compared to patients receiving PD who did not undergo surgery.