A reflection on what is most difficult to grasp in surgery, yet at the same time most essential — time.

Time understood not only as the sequence of operative events, but as a space of change: in our clinical practice, in technology, in the way we think about materials, and even in how we define success in hernia treatment.

This session is an invitation to view herniology through the lens of transformation — the evolution of concepts that has led us from the first biological and synthetic meshes, through the development of the philosophy of the “ideal implant” to the moment when we begin to understand that a mesh may not be a finished product, but an individualized response to a patient’s anatomical conditions.
We will also discuss one of the most important challenges of contemporary medicine — the definition of surgical outcomes. In an era of transparent science and digital tools, surgical success does not end with the absence of recurrence, but encompasses functionality, quality of life, biomechanics, patient perception, and long-term data.

A vision of the future of surgery… will the robot take over the role of the surgeon? Or perhaps it is not robots that will replace surgeons, but rather those surgeons who fail to master robotics and artificial intelligence who will be replaced by those who do.

The TIME Session is a manifesto — a multidimensional journey through time: literary, technological, scientific, and practical.

Session II moves us from the realm of ideas and future directions of development onto solid, tangible ground — to Earth, a symbol of foundations, experience, and what is absolutely essential in hernia surgery. This is the moment when we remind ourselves that before reaching for robotic technologies, artificial intelligence, or new materials, we must be certain that our roots are strong. Without a stable foundation, even the most promising innovation will not endure. This session speaks about what truly determines the success of treatment. It emphasizes that the philosophy of operating on the abdominal cavity is not limited to the choice of technique, but is rooted in a deep understanding of tissues, the operative field, and the consequences of every step.

Earth also represents proper patient selection — the awareness of which conditions require intervention and which should not be labeled as hernias at all. In an era of overdiagnosis, we return to the roots of diagnostics, recognizing that sometimes the best decision is not to operate. At the same time, we look deeper into the abdominal cavity, reminding ourselves that the “soil” can be difficult: adhesions, incarcerated intestinal loops, increased intra-abdominal pressure. Operating under such conditions requires not only technical skill, but also humility — an awareness that anatomy and physiology do not always cooperate.

This is also a session about practical knowledge that is often overlooked in textbooks, yet in real life determines patient outcomes. It highlights how proper risk assessment, preparation, understanding of biomechanics, and patience can achieve more than even the most spectacular technique.

The Earth Session is a return to the basics — to those elements which, though sometimes considered obvious, create the conditions for everything good in hernia surgery. Only on such ground can innovation be built, good treatment outcomes achieved, and a harvest gathered that has real value.

This session is devoted to what is often the most difficult to grasp in hernia surgery — because it cannot be touched, measured by the size of an implant, or seen on a laparoscopic screen.

It is Air — the entire “invisible” foundation that determines the success of treatment just as much as the surgical technique itself. Air is omnipresent, yet we become aware of it only when it begins to run out.

This session addresses a subtle, often overlooked layer of medicine: the patient’s emotions, fears, and perception of the entire treatment process. It speaks to the fact that patient participation in decision-making and preoperative preparation is not an optional addition, but a fundamental element of care. It highlights that the development of surgery cannot exist without the parallel development of anesthesiology and modern perioperative care protocols. It emphasizes that even before the procedure, we can meaningfully increase a patient’s chances — improve their condition, prepare them physically and mentally, and make them “better” more ready for surgery and recovery.
It is also a look at the invisible mechanism of the healthcare system — logistics, procedures, and the organization of care, which function like air: when everything works properly, no one thinks about it, but when something fails, the absence is immediately felt. And finally, it is a reflection on the team — because the collaboration of surgeons, anesthesiologists, nurses, physiotherapists, psychologists, and the entire medical staff is precisely the “air” that every patient breathes.

The Air Session reminds us that the success of an operation begins long before the first incision and continues long after the patient leaves the operating room. It is what cannot be seen, yet is absolutely essential. It is care, communication, preparation, safety, comfort, and respect for the patient. It is the element that — like air — we value most when it suddenly becomes scarce.

Session IV is devoted to the element that best reflects the dynamics of contemporary hernia surgery: Water. It is a metaphor for constant movement, change, the interaction of forces, and the understanding that no knowledge and no concept exists in isolation. Water can unite, but it can also divide — and its continuous flow is what sets the pace for the development of the entire field.

In hernia surgery, collaboration and differences of opinion are two sides of the same phenomenon. The confrontation of experiences, competing concepts, different schools of thought, diverse scientific communities, and varying interests is not a threat, but a driver of progress. Just as rivers carve new channels, so discussion shapes new standards.

In this session, we examine the sources of knowledge and how to navigate them: should every surgeon perform hernia surgery, or should the field enter a phase of full specialization? Does the development of herniology require a broad approach or focused mastery? Water poses questions about the direction of flow.

We will move further downstream — toward scientific research, guidelines, and consensus statements. These provide the riverbanks, attempting to organize the stream of opinions. At the same time, there remains room for interpretation, experience, and local realities. In hernia surgery, nothing is absolutely fixed — just as the current of water is never identical.
We then dive into deeper layers of knowledge: advanced techniques, new tools, reconstructive strategies, botulinum toxin, and the experience of leading centers. This is a reminder that progress does not occur linearly — it flows in multiple directions, encounters obstacles, rebounds from the banks, and creates eddies of new ideas. The time has come to rethink rectus abdominis diastasis. This issue, long treated as marginal, has today become a distinct current within abdominal wall surgery.

We will demonstrate that the flow of knowledge and collaboration between bariatric surgery and herniology is a necessity, not an option. This is an area where shared decisions form the most important tributaries feeding the river of good treatment outcomes.

Fire — an element that is intense, dynamic, and difficult to control. In this session, there are no lectures, no rigid structure, no safe or polished answers. This is a space where knowledge collides with experience, viewpoints clash, and every clinical issue can ignite from the smallest spark. The session is a living organism, driven by nine experts, a moderator, and an audience that is meant to become part of this fire.

Just as fire purifies and reshapes space, this session aims to expose what is most difficult and most controversial in modern herniology. One of the hottest topics is the role of databases and their relationship to classical randomized controlled trials. What truly drives the development of the field: large clinical registries or the gold standard of RCTs? Or does the real strength lie in combining these two worlds?

Another area is social media — today both a source of knowledge and a space of uncontrolled information. How should this content be verified? How do we distinguish inspiration from error? Can global initiatives, such as international surgical communities, act as promoters of new solutions, or should they rather function as quality filters? The fire of discussion will be particularly intense here, because everyone in the room is part of this ecosystem.

The most incendiary part of the panel will be the discussion on hernias in women of reproductive age, on anatomical and functional differences that are still insufficiently reflected in everyday practice. Aesthetics, specific symptom profiles, differences in inguinal hernia surgery, and varying strategies for the treatment of rectus abdominis diastasis — these are topics that demand sensitivity, experience, and the courage to address them openly. The panel will bring together female experts who will confront diverse approaches, arguments, and observations from around the world.

The Fire Session represents the highest temperature of the entire conference. This is not a discussion held “for form’s sake” — it is a conversation that may change the way the room thinks. An element that burns through the courage to ask difficult questions, the strength to allow multiple perspectives, and the readiness to challenge one’s own beliefs.

Fire can burn — but it can also illuminate the path.
This session is meant to do both.