Mininvasive surgery in abdominal wall repair: lights and shadows

The field of abdominal wall hernia surgery has seen a rapid evolution over the past few decades. This evolution has significantly benefited from the introduction of new techniques and materials that have markedly improved patient outcomes. A prime example of this evolution is the transformation of surgical techniques for inguinal hernias through the concepts of "tension-free" and "sutureless" methods. Traditionally, inguinal hernia repairs involved suture techniques that created tension on the tissues, increasing the risk of recurrence and postoperative pain. With the introduction of "tension-free" methods, such as the Lichtenstein technique, it became possible to use prosthetic meshes to reinforce the inguinal canal wall without tension. These methods dramatically reduced the recurrence rate, which had been the primary problem in hernia surgery up to that point. The subsequent introduction of "sutureless" techniques further improved outcomes by reducing tissue trauma and postoperative pain, thereby accelerating recovery times. Today, the advent of minimally invasive surgery has shifted research focus to other critical aspects beyond recurrence. These include chronic postoperative pain, seromas, costs, and hospital stays. These new goals and resulting new techniques aim to further enhance patients' quality of life and optimize healthcare resources, marking a new era in anterior abdominal wall hernia surgery. However, we must critically assess