From repair to reconstruction: a holistic perspective in abdominal wall hernia surgery

The field of abdominal wall hernia surgery is transitioning from a traditional focus on anatomical repair to a more comprehensive model centered on functional reconstruction. This paradigm shift expands the primary goal from mere defect closure to the restoration of abdominal wall integrity, dynamic stability, and physiological function. This perspective article examines this progression and highlights the critical role of integrating functional reconstruction with structured perioperative management to enhance long-term surgical outcomes and patient quality of life. We explore the clinical impact of technical innovations-including minimally invasive component separation, advanced prosthetic materials, and robotic-assisted techniques-alongside the implementation of individualized perioperative care pathways. Multidisciplinary collaboration is emphasized as a foundational framework for delivering personalized treatment. Several challenges remain, including optimal material selection, comparative evaluation of surgical approaches, and health economic assessments. Addressing these issues requires robust prospective studies to strengthen the evidence base. Future directions should prioritize the development of standardized functional assessment tools, the integration of artificial intelligence in surgical planning, and the incorporation of function-oriented principles into surgical education and practice. Through these advancements, abdominal wall hernia surgery can fully evolve into a patient-centered specialty focused on achieving sustainable, long-term benefits.