There is no doubt that complex abdominal wall repair procedures constitute major surgery. Real loss of substance, deep infections, and multiple relapses, especially in patients with comorbidities, can result in highly complex situations in different surgical stages: presurgical optimisation, the surgery itself, and peri- and post-surgical management.

In addition to proving highly challenging even for the most expert surgeons, the management of these situations can be extremely costly for departments and hospitals alike. For all these reasons, it now seems inevitable that these cases will increasingly be concentrated in specialist centres that, in addition to being equipped with indisputable specific anatomical knowledge, specific surgical experience and in-depth understanding of these problems, are used to dealing with complex situations, and are also well resourced and efficiently run.

It is now clear that not all hospital surgery departments can or should take these patients.

In line with what we have seen in the fields of pancreatic and hepatobiliary surgery, specialist centres of reference are now emerging also for patients requiring surgery for reconstruction of complex abdominal wall defects.

An important initiative in this regard, launched by the European Commission and, in particular the UEMS, is the introduction of a European Board of Surgical Qualification (EBSQ) examination in abdominal wall surgery.

The first exam session was held during the recent HERNIA 2021 meeting in Copenhagen, and may be seen as the first step towards European certification in this specialty field, which in turn is the natural prelude to the establishment of dedicated centres of excellence.

Many of the articles in this issue of Hernia come from outstanding and internationally renowned centres and focus on precisely the difficult situations mentioned above.

Giampiero Campanelli (Editor-in-Chief)

Note from the Editors

As the current year draws to a close, we are delighted to be able to share with you the results set out in the tables below, which show how our prestigious journal has gone from strength to strength over the past 3 years.

We extend our grateful thanks to all the members of the International Advisory Board, our section editors, reviewers, authors and readers.

Giampiero Campanelli, Editor-in-Chief, and the Associate Editors Jie Chen, Diego Cuccurullo, Namir Katkhouda, Davide Lomanto, Rachid Sani

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Tables 1 and 2.

Table 1 Journal’s performance in the latest 3 years
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Table 2 Geographical origin of the manuscripts
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