Interparietal hernias represent an old recognised yet persistently misunderstood entity in abdominal wall surgery. Biomechanically, defects in the posterior abdominal wall permit contents to herniate through and become trapped within the abdominal wall. The history of Lower Abdominal Transverse Incisions and their hernias spans more than three centuries, reflecting the evolution of anatomical knowledge and surgical exploration.

The earliest descriptions of interparietal hernias date back to the 17th century, with observations attributed to early anatomists who noted hernial sacs developing between the layers of the abdominal wall rather than following the expected inguinal canal trajectory [3]. However, it was not until the 18th and 19th centuries that these hernias were more systematically described. Authors such as Petit, Cloquet, and Hesselbach recognised aberrant hernia paths and emphasised the role of abnormal anatomy in preventing normal descent of the hernia sac into the scrotum [4].

The term interparietal hernia gained wider acceptance in the 19th century, particularly through the work of Sir Astley Cooper, who provided detailed anatomical dissections illustrating hernial sacs lodged between the layers of the abdominal wall musculature rather than beneath the skin or into the scrotum [5]. Cooper’s work was pivotal in recognising that these hernias were not surgical curiosities, but rather a consequence of specific anatomical and developmental constraints [6]. was the oldest citation found where the author presented 14 pages of discussion about the “Hernie inguino-interstitielle”.

By the late 19th and early 20th centuries, authors such as [7, 8] further refined classification systems, distinguishing between properitoneal, interstitial, and superficial interparietal hernias. These classifications remain foundational today. Importantly, these early surgeons recognised that many interparietal hernias were diagnosed only intraoperatively or at autopsy, often in the context of bowel obstruction, strangulation, or unexplained groin pain. Mortality rates reported in early series were high, reflecting both delayed diagnosis and limited surgical options of the era.

A recurring historical theme is the strong association between interparietal hernias and congenital anomalies, particularly undescended or ectopic testes. Nevertheless, numerous reports of interparietal hernias in women and in men with normally descended testes challenged a purely congenital explanation and suggested a multifactorial etiology involving mechanical forces, repeated hernia reduction, and acquired weaknesses of the abdominal wall.

Despite several of reported cases throughout the 19th and 20th centuries, interparietal hernias gradually faded from mainstream surgical consciousness [9–24]. As imaging techniques improved and hernia classifications simplified, these complex anatomical variants were often subsumed under broader diagnostic categories or overlooked entirely. This historical neglect has contributed to ongoing underdiagnosis and misattribution of symptoms.

Revisiting the historical literature reveals that interparietal hernias were never truly rare; rather, they were well recognised by earlier surgeons who relied on meticulous anatomical exploration [24, 25].

During the 1800s, the use of lower abdominal transverse incision was uncommon due to concerns about significant haemorrhage and mortality [26], until Johannes Pfannenstiel, described and reported it as a useful incision for caesarean sections in 1900 [27]. His thesis provided evidence that it was a quick, cosmetically sound, and safe approach to the uterus with a significant advantage of low hernia rate. It grew so popular that whenever a lower abdominal transverse scar is discovered during a physical examination, the non-specialist physician will probably characterise and record it as a ‘Pfannenstiel incision’ in the medical notes. However, Pfannenstiel acknowledged that his incision was in fact a modification of an earlier LATI method, “suprasymphyseal cross section” [28] (in which skin is open transversely, but fascia longitudinally) by Otto Ernst Küstner in 1896; a technique which is still used by some in contemporary surgical practice. Few years later Alfred E. Maylard described, in 1907, higher transverse incision where all the layers including rectus muscle were incised transversely [29]. Later, in 1941, Leonid S. Cherney, proposed a modification on Maylard’s technique called “New Transverse Low Abdominal Incision” advocating a much lower incision of the rectus muscle, across its tendon 1 cm from pubic bone [30]. For more than 50 years Pfannenstiel was Joel-Cohen, in 1972, described a higher and straight incision for avoiding bladder injury, opening the peritoneum transversely, not longitudinally [31]. His incision became well recognised by reducing operative time for hysterectomy and later was also used for c-sections. The most recent advancement in non-cutting LATI was in the 1990’s, when Michael Stark modified Joel-Cohen incision. Stark proposed sharp dissection and not closing the peritoneum [32].

LATI are less prone to large incisional hernias and therefore have a low incidence compared with midline incisions. Incidence of hernia in Lower Abdominal Transverse Incisions are reported to be lower compared to midline vertical incisions [24, 33–38]. However, the fact of the abdominal wall is open transversely in layers, is the explanation why the hernia is not full thickness, as most of the time only one layer is compromised causing the interparietal herniation. Interparietal hernias occurring after any type of LATI are usually miscalled Pfannenstiel hernias, but this does not address the physiopathology and specific complications to one or other method. Currently it is impossible to link one of the methods to a specific presentation or complication and therefore a more generic classification would be more appropriate.

Similar to what was described by Lower and Hicken [25], these hernias are a challenging diagnosis and usually pick up during a surgical procedure. In 1946, Dickinson conducted a review of the literature to report three cases of occult hernia [25], confirming that the symptoms were often confusing and that in most cases diagnosis was made during surgery or occasionally at autopsy, which still happen nowadays [39]. So, having these hernias for a long period causing pain is not uncommon and likely many chronic pain and IBS are related to his pathology.

Computed tomography allows the evaluation of suspected abdominal hernias and detection of clinically occult hernias [40–42] although some ventral hernias may not be apparent when the patient is supine. Dynamic ultrasound is good alternative, but it may lack specificity, and diagnostic laparoscopy may be required for a definitive diagnosis [43]. Modrzejewski reported three cases of interstitial hernia found during laparoscopic exploration of the front abdominal wall performed due to incisional wound site pain where ultrasound was negative [44]. Misinterpretation or misdiagnosis of imaging findings may occur. In our experience, LATI-H have been reported radiologically as divarication, diastasis, intraparietal lipoma, or omentum adherence to fascia as the eyes are usually focused on the herniation through the whole abdominal wall and herniations between layers are very subtle and can be neglected.