Beyond acronyms: a domain-based structural analysis of abdominal wall hernia repair techniques in the contemporary literature

Background Surgical techniques in abdominal wall surgery are commonly described using labels, including acronyms, eponyms, and narrative descriptors, that only partially capture their technical characteristics. Whether these labels correspond to genuinely distinct procedures or instead represent variations within a smaller number of underlying technical configurations remains empirically untested. Methods Building on our methodological study of reporting completeness, we performed a structured domain-based analysis of abdominal wall hernia repair techniques. Each surgical arm was decomposed into five predefined operative domains: surgical approach (A), hernia type (H), mesh position (M), mesh type (T), and fixation method (F). Unique technical configurations were defined as distinct domain combinations. Terminological redundancy was evaluated by mapping labels to their corresponding configurations. Technical diversity was quantified using Shannon entropy. Results Two hundred studies met inclusion criteria, yielding 290 surgical arms. Domain decomposition identified 184 unique technical configurations. Among 170 unique labels, 21 (12.4%) mapped to more than one five-domain configuration. Conversely, among 93 fully specified configurations linked to at least one label, 21 (22.6%) were described by more than one label. The most polysemous label (TEP) corresponded to 24 distinct configurations. Groin hernia repairs accounted for the largest number of arms (n = 130) but showed moderate structural diversity relative to sample size, whereas ventral and incisional repairs demonstrated higher variability per arm. In the sensitivity analysis restricted to the 149 fully specified arms, 94 unique configurations were identified; polysemy and redundancy remained substantial (TEP mapped to 11 configurations). Conclusion Abdominal wall hernia repair techniques are more completely represented when the labels in common use— acronyms, eponyms, and narrative descriptors—are supplemented by structured operative domains rather than relied upon in isolation. Domain-based descriptors provide a reproducible, machine-readable complement to existing nomenclature that may improve reporting clarity, support comparative research, and facilitate structured classification of surgical techniques.