LAUSR

We present our experience of developing a successful AWR MDT in a Tertiary Referral Centre, which aimed to optimise the management of complex AWR patients. The weekly AWR MDT was established in August 2020. Cases are discussed with a hollistic approach. A comprehensive individualised plan is agreed regarding appropriateness of surgery, pre-operative risk factors requiring optimisation and operative specific decisions. 151 patients have been discussed to date (118 incisional hernias, 33 primary). In 65% of patients, at least one risk factor for adverse surgical outcomes was identified that required pre-optimisation, most commonly the need for weight loss (93%), glycemic control (22%), & smoking cessation (22%). 50 patients have been operated on to date. Retrorectus repair was the most commonly used technique (86%). Adjuvant techniques such as peritoneal flaps were suggested in 36% of patients. 23 patients are currently on waiting list for surgery, 45 remain in their prehabilitation period. 20 patients did not undergo surgery after combined patient and MDT decision. 8 patients await further investigation and 5 patients have been transferred to other centres due to specialist input requirement. MDT management of abdominal wall hernias remains poorly established in most regions. Our experience highlights how vital it is. We have proven that it is feasible to run MDTs and that it has improved pre-operative planning and focus on modifiable risk factors in our centre. We would encourage other centres to establish this for complex cases, so that the most appropriate decisions can be made for this surgically challenging group.