International reproducibility of the Muysoms A–H–M–T–F nomenclature for standardized reporting of hernia repair: The ARMONIA (Achieving Reliability and Methodologic standardizatiOn in Nomenclature for abdomInal wAll surgery) multicenter survey

Background: The proliferation of acronyms in abdominal wall surgery has fragmented procedural language, limiting comparability across studies, registries, and operative reports. The Muysoms A-H-M-T-F nomenclature was proposed to standardize hernia repair description across 5 key dimensions; however, its inter-rater reproducibility among independent surgeons has not previously been evaluated. Methods: An international cross-sectional survey was conducted among surgeons with hernia repair experience, who were invited to independently code 15 clinical scenarios using the A-H-M-T-F system. For each case, respondents rated their confidence, assigned a classic nomenclature label, and provided qualitative feedback. Percentage agreement and Fleiss' kappa were calculated for each nomenclature component and for the full 5-component code. Variability in classic terminology was compared with Muysoms coding variability before and after format normalization. Results: Seventy-two surgeons from 4 continents completed the survey; 83% had not previously used the nomenclature. Mean percentage agreement on the modal response was highest for mesh position (99.0%) and hernia type (95.3%), followed by mesh type (93.5%), fixation (89.4%), and approach (87.2%). Fleiss' kappa was substantial for mesh position (0.735), hernia type (0.726), and fixation (0.672), and moderate for approach (0.591), mesh type (0.559), and the full code (0.484). After format normalization, the Muysoms system reduced procedural naming variability by 72% compared with classic free-text terminology. Conclusion: The Muysoms nomenclature demonstrated moderate-to-substantial inter-rater reproducibility, even among predominantly first-time users, and reduced procedural naming variability. These findings support its potential role in standardized operative reporting, registry-based research, and comparative studies in abdominal wall surgery.