Lower abdominal transverse incisions, or LATIs, are the horizontal cuts made across the lower belly to reach the uterus, bladder, pelvic organs and lower bowel. They are the standard approach for caesarean section, which alone accounts for nearly 30 million births each year worldwide, and they are equally routine in gynaecology, urology and general surgery. Because these incisions heal with a low rate of the full-thickness hernias seen after vertical midline cuts, they have long been considered forgiving. The Edinburgh group’s narrative review, which combed MEDLINE and PubMed from database inception to March 2025 and included translated non-English literature, suggests that this reputation has allowed a subtler problem to hide in plain sight.

The crux of the argument is anatomical. When a midline incision fails, the whole thickness of the abdominal wall gives way and bowel or omentum pushes straight through to lie under the skin. Transverse lower abdominal incisions, however, open the wall in layers: skin transversely, fascia in a separate manoeuvre, muscle and posterior sheath according to the specific technique. When healing fails, it often fails in only one of those layers. The result is an interparietal hernia, in which abdominal contents slip between the planes of the wall itself rather than through it, creating a defect that can be large internally yet nearly invisible externally.

These hernias are frequently swept into large series of generic incisional hernias, where their distinctive anatomy is lost. The authors describe them as typically a mix of a sizeable posterior defect with smaller defects in the more superficial layers, a pattern quite different from other incisional hernias. Because the bulge may be contained within the wall, patients can present with chronic pain, unexplained pelvic symptoms or intermittent bowel complaints rather than an obvious lump. The review notes that such hernias can progress to bowel obstruction and bowel ischaemia, making delayed recognition genuinely dangerous.

The terminology problem is historical. Interparietal hernias, in which the sac is trapped between the layers of the abdominal wall, were described as early as the seventeenth century and systematically characterised in the eighteenth and nineteenth by anatomists and surgeons including Petit, Cloquet and Hesselbach. Sir Astley Cooper’s detailed dissections in the 1800s established that these were not curiosities but the consequence of specific anatomical constraints, and by the early twentieth century classifications distinguishing properitoneal, interstitial and superficial interparietal hernias were already in place. Early series reported high mortality, largely because the diagnosis was made only at operation or autopsy, often in patients with strangulated bowel.

Historically, interparietal hernias were strongly associated with congenital anomalies, particularly undescended testes, which is one reason they faded from surgical consciousness as imaging improved and attention shifted elsewhere. But reports in women and in men with normally descended testes pointed to a multifactorial origin involving mechanical forces and acquired weaknesses of the wall. The Edinburgh authors argue that the iatrogenic version, produced by the surgeon’s own incision, deserves its own category rather than being treated as a rare congenital curiosity.

The story of the incisions themselves explains why the naming matters. Johannes Pfannenstiel popularised the suprasymphysarial fascial cross-section for caesarean section in 1900, praising its speed, cosmesis and low hernia rate, though he acknowledged modifying Otto Küstner’s 1896 technique, in which the skin is opened transversely but the fascia longitudinally. Alfred Maylard described a higher transverse incision cutting all layers including rectus muscle in 1907, and Leonid Cherney proposed in 1941 dividing the rectus at its tendon close to the pubic bone. Joel-Cohen introduced a higher straight incision in 1972, and Michael Stark modified it in the 1990s with sharp dissection and non-closure of the peritoneum. These techniques differ markedly in which anatomical planes are divided and how they are closed, yet all their hernias are colloquially lumped together as Pfannenstiel or caesarean-section hernias.

That habit, the authors contend, obscures the link between technique and complication. Because the wall is opened transversely in layers, herniation after a LATI is usually not full thickness; a single compromised layer is enough to create an interparietal defect. Currently it is impossible to connect any particular incision type to a specific presentation, which is precisely why the authors favour a generic umbrella term that can be refined by future research rather than perpetuating a name that describes only one of several operations.

Diagnosis compounds the problem. Computed tomography can detect clinically occult abdominal hernias, though some ventral hernias disappear when the patient lies supine. Dynamic ultrasound is a useful alternative but may lack specificity, and diagnostic laparoscopy is sometimes required. One reported series described interstitial hernias found only at laparoscopic exploration of the abdominal wall in patients with incision-site pain and negative ultrasound scans. The authors add from their own experience that LATI-Hs are frequently misreported radiologically as divarication of the recti, diastasis, intraparietal lipoma or simple omental adhesion to fascia, because radiologists’ eyes are trained to look for herniation through the whole wall rather than between its layers.

Confusion extends to neighbouring entities. Lateral LATI-Hs, arising where the incision extends beyond the lateral border of the rectus sheath, are often reported as Spigelian hernias. The two look similar in location and morphology, but Spigelian hernias are primary defects through the Spigelian fascia between the transversus abdominis and internal oblique aponeuroses, whereas lateral LATI-Hs are iatrogenic, occurring when posterior muscular layers are left open or closed inadequately. Mislabelling them, the authors argue, prevents accurate reporting and stalls the development of management guidelines.

The practical stakes are considerable. Estimated hernia rates after caesarean section range from zero to 5.6 percent in the literature, which, applied to tens of millions of procedures, implies a substantial global burden concentrated in young women, many of whom may have their chronic pelvic symptoms attributed to other causes. Standardised terminology, the authors argue, is the prerequisite for everything that follows: consistent documentation, rational design of clinical trials, core descriptor and outcome sets, and ultimately evidence-based strategies for prevention and repair. Without a defined disease, patients cannot be recruited to studies, and without studies, surgical practice cannot improve.

The proposal is deliberately simple. Call these hernias what they are, lower abdominal transverse interparietal or incisional hernias, and record which incision produced them. That single change in vocabulary, the team argues, would transform an overlooked complication of some of the world’s most common operations into a researchable, preventable and treatable condition, and give a name at last to the many patients whose pain has never had one.

Subject of Research: Proposal of the term LATI-H for hernias following lower abdominal transverse incisions

Article Title: Why LATI-H must enter the surgical lexicon

Article References: Zanellato, A., Lucocq, J., Brown, L., Drake, T. M., Berrevoet, F., & Wigmore, S. J. (2026). Why LATI-H must enter the surgical lexicon. Journal of Abdominal Wall Surgery, 5, Article 16806. https://doi.org/10.3389/jaws.2026.16806

Image Credits: AI Generated

DOI: 10.3389/jaws.2026.16806

Keywords: LATI-H, incisional hernia, interparietal hernia, caesarean section, Pfannenstiel incision, abdominal wall surgery, hernia diagnosis, surgical nomenclature, Spigelian hernia, abdominal wall anatomy, postoperative complications, hernia repair