Content—Part A
Introduction
Chapter 1. How comparable are incisional and ventral hernias in terms of operative technique and outcomes?
Bruce Ramshaw MD
Level 3 | There are differences in outcomes when treating primary ventral hernias compared with incisional and/or recurrent ventral hernias |
Grade B | When studying ventral hernias, the analysis of primary ventral hernias should be done separately from the analysis of incisional and recurrent ventral hernias |
Chapter 2a. Is the routine application of computed tomography (CT) and magnetic resonance imaging (MRI) recommended for the diagnosis of ventral hernias before laparoscopic ventral hernia repair?
R Schrittwieser, F Mayer, H. Niebuhr
Level 4 | A CT-scan can be helpful in predicting wound complications and the need for complex abdominal wall repair techniques |
Level 4 | Preoperative determination of abdominal wall defect ratios and hernia defect areas may be helpful to predict abdominal wall closure after Component Separation Techniques (CST) |
Grade D | In bigger or incarcerated hernias, a CT-scan may be considered for better planning of op-strategy and patient information |
Grade D | In planned CST, a CT-scan can be helpful to predict abdominal wall closure |
Level 3 | There is high interobserver variability in detecting a ventral hernia with CT-scan; exact definitions for a radiographic recurrence are needed |
Chapter 2b. Key question: Can the routine application of ultrasound imaging be helpful in detecting ventral hernias and rectus diastasis preoperatively?
H Niebuhr, R. Schrittwieser
Level 4 | The evidence for the use of US in the daily routine is insufficient |
High-frequency US can be helpful in depicting/diagnosing epigastric abdominal wall hernias and incisional hernias of limited size | |
The Field of view (FOV) can be extended by using panoramic ultrasound view | |
Further information can be gained by using shear wave elastography (SWE) |
Grade C | The reliability of shear wave elastography (SWE) in diagnosis of abdominal wall hernia disease should be further evaluated |
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an incarcerated epigastric hernia in an elderly patient,
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a clinical manifestation of a tumor formation on the abdominal wall: differential diagnosis,
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a chronic infective osteomyelitis of the xiphoid process of the sternum (DD Abdominal wall hernia) in a young woman,
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an incarcerated small bowel in the hernia with no flow in the mesentery in a 90-year-old man,
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an emergent case of a Spigelian hernia involving the appendix.
Level 4 | High-frequency US can be helpful in depicting/diagnosing/measuring of a rectus diastasis |
The Field of view (FOV) can be extended by using panoramic ultrasound view |
Grade A | High-frequency US is recommended to depict/diagnose/measure a rectus diastasis |
Panoramic ultrasound view can be used to extend the Field of view (FOV) |
Chapter 3. Classification
U.A. Dietz, A. Wiegering
Level 2B | The EHS ventral and incisional hernia classification is validated (external validation) |
The EHS classification is useful for identifying patients at risk for complications | |
The classification of Dietz et al. is validated (internal validation) | |
Hernia gap width is of prognostic relevance regarding postoperative complications (SSO) | |
Hernia gap length is of prognostic importance regarding recurrence rate | |
Ventral and incisional hernias are distinct entities with different prognosis | |
Level 5 | A consensus exists among experts that it is necessary to classify ventral and incisional hernias as well as parastomal hernias prospectively, to create a useful data set to improve understanding of the disease, to allow comparability of results, to substantiate patient counseling, and to optimize therapeutic algorithms |
The acceptance and application of the available classifications remained low in the period from 2013 to 2018 |
Grade D | The European Hernia Society (EHS) classification for ventral and incisional hernias is recommended |
Chapter 4: Indications for treatment dependence on size of defect or hernia sac, hernia type, symptoms, and age
Zhenling Ji, Junsheng Li and G. Woeste
Level 2 | Elective surgery improves hernia-related QoL and functional status (low- and moderate-risk patients), while emergency repair leads to higher morbidity and mortality |
Level 2 | Small hernia defects predict emergency repair (umbilical hernia defects between 2 and 7 cm and incisional hernia defects up to 7 cm) The size of the defect was an independent predictor for recurrence and postoperative complications |
Level 3 | Watchful waiting is safe for incisional and umbilical hernias, but it leads to high crossover rates (11–33%) with significantly greater incidence of intraoperative perforations, fistulas, and mortality for emergency surgery |
Level 3 | Older incisional hernia patients tend to have poor outcomes after incisional hernia repair |
Grade B | Watchful waiting is suggested for medical optimization in patients with modifiable risk factors |
Grade B | It is recommended that symptomatic hernias should be treated surgically. The laparoscopic technique should preferably be reserved for defect sizes smaller than 15 cm in diameter |
Chapter 5. Is there still a place for open suture repair depending on defect size?
J. Kukleta, S. Morales-Conde
Level 1A | A mesh repair reduces the number of recurrences significantly. The suture repair is associated with more recurrent hernias than mesh repair |
Level 2 | Sublay mesh location may result in fewer recurrences and SSIs than onlay or inlay placement |
Level 3 | Surgical site infections and seromas are more common with mesh repair |
Rectus diastasis (divarication recti) is a significant risk factor for increased recurrence rate in repair of small midline hernias |
Grade A | Mesh reinforcement is recommended for all VH repairs (diameter > 1 cm) in a clean case |
Grade B | Mesh reinforcement is suggested in even small umbilical or epigastric hernias (diameter > 1 cm) to lower the risk of reoperation for recurrence |
It is suggested that patients with small midline hernias and concomitant divarication recti should receive a mesh repair to decrease the risk of recurrence |
Approach | Recurrence (%), CI (n/N) | Complications (%), CI (n/N) | Postoperative pain (%), CI (n/N) |
---|---|---|---|
Laparoscopic | 1.0, 0.0–2.0 (3/312) | 25.2, 18.1–32.3 (36/143) | 0.0, 0.0–11.5 (0/26) |
Open | 2.3, 1.4–3.2 (25/1068) | 10.2, 8.1–12.2 (85/835) | 9.8, 7.0–12.6 (42/429) |
Chapter 6. Obese patients and incisional hernia
F. Köckerling, P. Chowbey, R. Khullar
Level 1A | Laparoscopic ventral and incisional hernia repair is associated with fewer wound infections and wound complications (stronger evidence) |
Level 2C | A BMI higher than 30 kg/m2 significantly increases the risk of recurrence (stronger evidence) |
Level 4 | Spinal anesthesia for laparoscopic ventral hernia repair in obese patients can be an alternative to general anesthesia (new statement) |
Grade A | For obese patients presenting with a ventral or incisional hernia, the laparoscopic approach is preferred because it reduces the wound infection and wound complication rates (stronger evidence) |
Grade B | As the recurrence risk for obese patients is higher, there may be a need for additional technical steps (greater mesh fixation, more overlap, suture closure of the defect) when the laparoscopic approach is indicated (stronger evidence) |
Chapter 7. Recurrence after open surgery—re-do better laparoscopically?
R Schrittwieser, F. Berrevoet
Level 4 | Complication rates after laparoscopic repair vary according to both hernia and patient characteristics and type of previous repairs |
Level 4 | There is no consensus in the literature on the complication rate according to previously used techniques |
Grade C | It is recommended that each case of recurrent hernia should be evaluated separately to judge best treatment |
Chapter 8. Evidence for antibiotic and thromboembolic prophylaxis in laparoscopic ventral hernia surgery
Rudolf Schrittwieser, B. Stechemesser
Unchanged Statements and recommendations |
Chapter 9 Positioning of the trocars and creating the capno pneumoperitoneum
Jie Chen, VK Bansal
Level 2 | There is no difference in major complication rates with direct trocar insertion without pneumoperitoneum compared with pneumoperitoneum with a Veress needle prior to initial trocar insertion |
Level 2 | Pneumoperitoneum creation with a Veress needle followed by entrance into the abdomen with an optical trocar is the method most frequently used |
Level 4 | The most safe place for insertion of the first trocar seems to be in the left (Palmer’s point) (or right) upper quadrant subcostally in the midclavicular line for midabdominal and lower abdominal hernias |
Grade B | It is recommended that the Veress needle and the first trocar should be inserted at Palmer’s point and as far as possible from the site of expected adhesions |
Grade B | It is recommended that the surgeons should use the access technique that they are most skilled with |
Grade C | It is recommended that secondary port placement should be performed under vision and placed as far as possible from the hernia defect and expected |
Adhesions as well to allow the surgeon to work in a favorable position for release of adhesions and placement/fixation of mesh |
Chapter 10 Port type, positions, and number in laparoscopic ventral hernia repair
David Radvinsky, Mazen Iskandar, George Ferzli
Level 2 | The use of radially expanding blunt-tipped trocars are associated with lower risk of trocar site bleeding, but data are lacking for major trocar-related complications between trocar types |
Grade C | It is recommended to use radially expanding blunt tip trocars where possible to reduce port-site bleeding |
Chapter 11. Principles of adhesiolysis
H. Hoffmann, J. Chen, K. LeBlanc
Level 2c | Enterotomy due to adhesiolysis is the most common intraoperative complication in VHR of which half occur during adhesiolysis |
Extensive adhesiolysis predicts increased rates for morbidity, enterotomy, surgical site infection and length of hospital stay | |
Compared to primary ventral hernia repair, incisional ventral hernia repair requires more adhesiolysis | |
Level 3 | Adhesiolysis is necessary in majority of patients undergoing VHR |
Prolonged adhesiolysis time and preexisting intra-abdominal meshes are independent risk factors for enterotomy |
Grade B | Adhesiolysis should be limited to reduce the risk of inadvertent enterotomy |
Grade D | Before completion of surgery, the bowel should carefully be inspected to identify any unrecognized enterotomies or thermal injury |
Chapter 12. Laparoscopic ventral or incisional hernia repair—importance of defining hernial defect margins and gaging the size of the hernia preoperatively and intraoperatively
P. Chowbey, A. Sharma
Level 2b | Among common methods of measuring abdominal wall hernia defect, sizes are only weakly to moderately correlated |
Level 2a | Large defect widths and total area have a greater chance of pain and activity limitation at 1-month follow-up, but not long term |
Level 3 | Dynamic rather than static measurements of ventral hernia area during laparoscopy provide a simple way of in vivo objective measurement that helps the surgeon choose the appropriate size of mesh |
Level 1 | Despite the ability to characterize ventral hernia morphology and recurrence with precision, most indexed studies do not employ imaging |
Grade B | Dynamic rather than static measurements of ventral hernia area during laparoscopy are recommended |
Chapter 13. Bridging–augmentation–reconstruction of the linea alba—closure of the defect before IPOM
J Kukleta, D. Chen, P. Chowbey, A. Sharma
Level 2A | The primary goal of the reconstruction of linea alba is the restitution of functionality of the abdominal wall. The improved cosmesis is a positive side effect |
Level 2C | Closure of the defect prior to intraperitoneal onlay mesh (IPOM-Plus) results in less recurrence, seroma formation, and bulging in some studies. |
There are significantly fewer adverse events noted following the closure of fascial defect when compared to non-closure repair | |
Closure of the fascial defect during laparoscopic ventral/incisional hernia repair reduces significantly seroma rate in the most studies | |
Level 3 | The bridged repair (cIPOM, c = classic) is associated with a significantly higher risk of hernia recurrence and a higher overall complication rate |
IPOM-Plus repair patients show better satisfaction with the result in some studies and have better functional status | |
Concomitant correction of diastasis recti in middle and lower abdomen defeats the muscular dysbalance of the trunk and its consequences | |
Some studies did not demonstrate the advantage of the defect closure over the non-closure repair | |
Some studies have reported similar postoperative outcomes in hernia defect closure and non-closure groups |
Grade B | The restoration of normal anatomy (reconstruction of linea alba) during the laparoscopic abdominal wall repair should be attempted |
Grade C | In case of too high tension while reconstructing linea alba, additional component separation techniques may be necessary |
Grade D | In large hernia repairs, additional measures (temporary chemical components relaxation with Botulinum toxin A, preoperative progressive pneumoperitoneum, or intramuscular expanders) must be considered in order to facilitate the defect closure/reconstruction of linea alba |
Chapter 14. How much overlap is necessary?
A. De Beaux, S Morales-Conde
Level 3 | Increasing hernia defect size, and reducing overlap size, among other factors was related to the risk of hernia recurrence |
Level 3 | The mesh area-to-defect area ratio appears to be more important to minimize recurrence, than a single-mesh overlap length (such as 5 cm) |
Grade C | The mesh area-to-defect area ratio should be at least 16:1. In other words, the radius of the mesh used should be at least four times the radius of the defect |
Grade C | The use of a rule such as a 5-cm mesh overlap for all hernia defects should be abandoned |
Grade C | As the defect size increases, the size of the mesh overlap should also increase |
Chapter 15/16. Fixation
R. Fortelny, M.C. Misra, V.K.Bansal, F. Köckerling, L. Jorgensen, J. Kukleta
Level 1A | The risk of hernia recurrence after tacker or suture fixation is similar |
Level 1B | The use of glue only fixation is associated with an increased risk for recurrence |
Level 2C | The use of absorbable tacks may be a risk factor for recurrence compared to non-absorbable tacks |
Grade A | Suture fixation alone or in combination with tacks or double-crown tacker fixation alone is recommended to minimize the risk of hernia recurrence |
Level 1B | Combined fixation with tacks and transfascial sutures causes more pain compared to double-crown tack fixation in the first 3 months |
There is no difference in postoperative pain between absorbable and non-absorbable tack fixation |
Grade B | The use of non-absorbable or absorbable tacks is equally recommended in terms of postoperative pain |
Level 1 B | The use of non-absorbable or absorbable tacks is equally recommended in terms of postoperative pain |
Grade B | Fixation by absorbable and non-absorbable tacks is equally recommended in terms of QoL. |
Level 1B | Non-absorbable tack fixation is cheaper in comparison to absorbable tack fixation |
Grade B | Non-absorbable tack fixation should be preferred to absorbable tack fixation in terms of cost |
Level 1A | The length of hospital stay after tacker and/or suture mesh fixation is similar |
Level 1B | The length of hospital stay after absorbable or non-absorbable tack fixation is similar |
Grade A | Different tacker/suture mesh fixation techniques are equally recommended in terms of hospital stay |
Level 4 | The use of penetrating fixation devices (tacks and sutures) above the costal margin is associated with the risk of pain and pericardial injuries |
Grade D | The use of penetrating fixation devices (tacks and sutures) is not recommended above the costal margin |
Above the costal margin, only non-penetrating fixation devices (e.g., glues) are recommended |
Grade B | Tacks should be placed at the costal margin, whereas additional transfascial suture fixation should be placed just below the costal margin |
For mesh fixation above, the costal margin and xiphoid glue should be used. |
Level 4 | Additional mesh fixation by bone anchors in complex suprapubic hernias is associated with a low recurrence rate |
Grade D | Additional mesh fixation by the use of bone anchors is suggested in complex cases |
Chapter 17. Mesh insertion
M. Misra, V. K. Bansal, R. Fortelny
No changes with regard to the original statements and recommendations which are still valid (—see “Surg Endosc (2014) 28: page 28”) |
Chapter 18. Management of bowel injury during laparoscopic ventral incisional hernia repair
Vadim Meytes, Kevin Bain, Karl LeBlanc, George Ferzli
Level 2 Adhesiolysis time was a significant and independent predictive factor for enterotomy |
Grade C | In cases of recognized bowel injury, without significant enteric fluid leakage, it is suggested that the enterotomy can be repaired, followed by a mesh repair of the hernia |
If there is a conversion to open surgery to repair the enterotomy, the hernia repair can be accomplished laparoscopically after an interval of 5–7 days if no signs of infection are present |
Chapter 19. Risk factors for infection in laparoscopic incisional/ventral hernia repair
P. Chowbey, F. Mayer
Level 2 | Following evidence-based guidelines and the specialized hernia clinic were associated with lower SSI rates |
Level 2 | A body mass index ≥ 30 kg/m2, smoking, American Society of Anesthesiology (ASA) class 3, open surgical approach, prolonged operative times, and inpatient admission following ventral incisional hernia repairs are significant predictors of postoperative SSIs |
Level 2 | Obesity and smoking are modifiable risk factors for SSIs after LVHR |
Level 2 | SSI was more common with open repair in both primary and incisional hernia groups |
Level 3 | The institution where surgery is performed and the number of prior abdominal operations are factors associated with SSI |
Level 3 | Postoperative infectious complications are similar between defect closure and non-closure patients |
Grade B | In terms of low SSI rates, the surgeons should follow evidence-based guidelines and the patient should be operated in institutions with appropriate expertise |
Chapter 20. Mesh Infection
F. Köckerling, P. Chowbey, A. Sharma
Level 1A | The rate of mesh infection after laparoscopic ventral and incisional hernia repair is low (1-2%) (stronger evidence) |
Level 1A | If bridging is required, the use of a biologic mesh for replacement results in a very high recurrence rate (new statement) |
Level 4 | When conservative treatment of a mesh infection after laparoscopic ventral and incisional hernia repair fails, either a synthetic or biologic mesh seems to work as a replacement when facial closure can be achieved (new statement) |
Grade D | If bridging is required, the replacement of an infected mesh can be performed with a synthetic mesh (new recommendation) |
Chapter 21. Postoperative Seroma: Risk Factors, Prevention, and Best Treatment
J. Bingener, B. Ramshaw
No changes in statements and recommendations with regard to incidence of seromas |
Level 3 | Robotic retrorectus approach may increase clinically detected seroma rate |
Level 3 | Closure of hernia defect may decrease seroma formation |
Level 4 | Abdominal binder may decrease seroma formation |
Level 4 | Injection of fibrin glue in the hernia sac may reduce seroma formation |
Grade C (meta-analysis of poor studies) | Surgeons should attempt to close the hernia defect when possible |
Grade C (case report and small retrospective study) | Surgeons can consider injecting fibrin glue to prevent seroma |
Chapter 22. Postoperative bulging
Jianxiong Tang, L. Jorgensen, ShaoJie Li, Lei Zhu
Level 3 | Failure to position/fix the mesh flat may contribute to postoperative bulging |
Level 3 | Larger hernia defect size is associated with a higher rate of postoperative bulging |
Level 4 | There is no significant difference in the incidence of bulging according to mesh fixation technique |
Level 4 | Mesh type may influence the rate of postoperative bulging |
Grade B | It is recommended that mesh should be tensioned appropriately such that the mesh is flat without any wrinkles/folds following desufflation of the abdomen |
Grade C | Larger defects need a larger overlap to resist the intra-abdominal forces. |
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Is bulging a result of insufficient overlap of the mesh?
Chapter 23. Chronic Pain—Risk Factors, Prevention, and Treatment
J. Bingener, W. Reinpold
Level 2A | LVHR results in chronic pain in up to 25% of patients |
Statement
| No change |
Level 2B | Local anesthetic at suture sites and as transversus abdominis plane block during surgery significantly decreases acute early pain |
Level 2A | Absorbable fixation tacks were not associated with less chronic pain |
Grade B | Surgeons should use intraoperative suture site or regional block injection of local anesthetic |
Statements and Recommendations
| No change |
Chapter 24. Recurrence after laparoscopic ventral/incisional hernia repair—risk factors, mechanism, and prevention
P. Chowbey, D. Chen, R. Khullar
Level 2c | Pregnancy after ventral hernia repair is independently associated with ventral hernia recurrence |
Level 4 | Previous interventions, postoperative complications, and Clavien–Dindo score > 2 are independent prognostic factors for recurrence |
Grade B | Female patients of reproductive age who wish to have ventral hernia repair should be advised on the increased risk of recurrence associated with subsequent pregnancy |
Level 1 | Mesh reinforcement is recommended for ventral hernia repairs in a clean case |
Level 3 | Sublay mesh location may result in fewer recurrences |
Level 1 | Risk of hernia recurrence decreases with increasing area of mesh overlap in laparoscopic procedures for ventral hernia repair |
Level 4 | Mesh-to-defect area ratio is an independent predictive factor for recurrence |
Grade B | Larger hernia defect sizes require greater mesh overlap to ensure that optimal mesh-to-defect area ratio is achieved |
Chapter 25. Comparison of open vs. laparoscopic hernia repair: Operation room time, bowel lesion, seroma, and wound infection
Jianwen Li, Fei Yue, Zirui He
Level 1B | Learning curve in terms of time of operation for LVHR is around 50 Cases (new statement) |
Level 2A | The laparoscopic approach has a significantly lower risk for wound infections in incarcerated/strangulated hernias (new statement) |
Level 3 | Missed bowel injuries are more common in laparoscopic surgery, and may lead to major complications (new statement) |
Identical to previous |
Chapter 26. Comparison of hospital stay, return to activity, cost, quality of life, pain, and recurrence after laparoscopic and open ventral and incisional hernia repair
Virinder Kumar Bansal, Aditya Baksi, Washim F Khan, A Krishna, MC Misra, R Fortelny
The original statements are still valid |
Level 2C | In patients with chronic liver disease or obesity, length of hospital stay is shorter in LIVHR compared to open repair |
Level 3 | Length of hospital stay is shorter in both reducible and irreducible ventral and incisional hernias in laparoscopic repair compared to open repair |
The original recommendation is still valid |
Grade C | Laparoscopic repair may be preferred in chronic lung disease (CLD), obesity, and for both reducible and irreducible hernias |
The original statements and recommendations are still valid |
The original statements are still valid. |
Level 2C | Laparoscopic ventral hernia repair is more cost effective than open repair |
Level 3 | Laparoscopic repair of ventral hernias in obese patients is more cost effective than open repair |
No new Recommendations |
Level 1A | Long-term QOL does not differ between laparoscopic and open incisional/ventral hernia repairs |
Level 1 3 | A Laparoscopic repair improves overall health-related Quality of Life (HRQoL) |
Level 1B | Short-term QOL is better after laparoscopic repair compared to open repair |
Grade B | Laparoscopic repair is recommended compared with open repair when considering HRQoL |
The old statements are still valid |
Grade A | Regarding the risk of postoperative pain both techniques—open or laparoscopic—can be recommended equally |
Level 1A | No significant difference in recurrence is found between open and laparoscopic incisional/ventral hernia repairs (stronger evidence) |
Grade A | Regarding the recurrence rate both laparoscopic and open techniques can be recommended equally |
Chapter 27. Do we have an ideal mesh in terms of prevention of adhesions? Are coated meshes really necessary? Are there data to support the manufacturers’ claims of superiority? Is permanent or absorbable barrier preferred?
F. Köckerling, D. Weyhe, M.C. Misra, J. Kukleta
Level 2C | In laparoscopic incisional hernia repair, composite meshes consisting of polypropylene sandwiched between two tissue-separating layers of a bioabsorbable coating have a significantly higher risk for recurrence and chronic pain compared to the other recommended meshes (new statement) |
Level 2B | A lightweight monofilament polypropylene mesh with an absorbable hydrogel barrier has in laparoscopic ventral/incisional hernia repair a low complication and recurrence rate (new statement) |
Level 2C | The mesh-related complication rate following laparoscopic incisional hernia repair is not higher as following open mesh repair (new statement) |
Level 4 | A hybrid synthetic/biologic mesh can be used in laparoscopic ventral/incisional hernia repair (new statement). |
Grade B | For laparoscopic incisional and ventral hernia repair, only meshes approved for implantation in the abdominal cavity should be used (stronger recommendation) |
Chapter 28. Role of biological/biosynthetic meshes in laparoscopic incisional and ventral hernia repair? Are they advantageous in infected abdominal wall?
B. Stechemesser, D. Weyhe, B. Ramshaw, F. Köckerling, G. S. Ferzli
Level 2b | Regarding short-term results (up to 24 months), open ventral hernia repair can safely be performed with biosynthetic absorbable mesh reinforcement |
Despite contaminated operating field, implantation of a biosynthetic mesh may be safe; however, the long-term durability seems less favorable than previously reported | |
Level 3 | Biological mesh and biosynthetic meshes have similar recurrence rates as synthetic meshes in contaminated ventral hernia repairs and may not be superior as previously thought |
Level 4 | There is no evidence supporting the use of biologic or biosynthetic meshes in laparoscopic ventral hernia repair |
Grade A | In the absence of higher-level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair |
Grade B | The laparoscopic use of biologic or biosynthetic mesh implantation is only recommended in controlled trials |
Chapter 29. What happens to synthetic mesh after it is inserted into the body?
Bruce Ramshaw MD, Michael Fabian MD, Dirk Weyhe MD
Level 4 | It appears that permanent synthetic (plastic) mesh used for hernia repair is not inert when placed in the patient’s body |
Level 4 | This biologic interaction is complex, and the effects can be quite variable |
Level 4 | Mesh alone does not cause chronic pain but may be a contributing factor in addition to other factors that result in chronic pain after inguinal hernia repair |
Grade D | Because currently there is no way to predict the biologic interaction of each patient to each available hernia mesh, the patient should be informed of potential interactions and complications. The complexity and variability of the biologic interaction also would argue against the restricted availability of mesh choices within a hospital or outpatient surgery center, allowing surgeons and patients to have options between a variety of mesh choices |
Grade D | Mesh removal may be an appropriate measure in addition to other procedures such as neurolysis and/or neurectomy in an attempt to relieve pain in a patient with chronic groin pain after inguinal hernia repair |
Chapter 30. Open abdominal surgery and stoma surgery: indications for prophylactic mesh implantation and risk reduction strategies
Qiyuan Yao, D. Weyhe, G. Woeste
Level 1 | A significant reduction in incidence of incisional hernia in patients undergoing elective midline laparotomy was achieved with prophylactic mesh reinforcement in onlay position compared with sublay mesh reinforcement and primary suture only |
Level 1 | Prophylactic mesh application at the time of primary colostomy formation is a promising method for the prevention of parastomal herniation |
Level 1 | Prophylactic mesh placement reduces the rate of incisional hernia in risk groups with morbid obesity, aortic aneurysm, or colorectal surgery |
Level 3 | Prophylactic mesh in the closure of emergency midline laparotomies is feasible for the prevention of incisional hernia |
Level 2 | Extraperitoneal colostomy was observed to lead to a lower rate of parastomal hernia and stoma prolapse versus transperitoneal |
Level 2 | Use of a resorbable synthetic mesh during emergency ostomy formation showed no significant preventive effect on formation of parastomal hernia after 1 year |
Grade B | Prophylactic onlay mesh reinforcement has the potential to become the standard treatment for high-risk patients undergoing midline laparotomy |
Grade B | There is no relevant difference between midline and transverse incisions regarding the incidence for incisional hernia formation |
Grade C | A prophylactic mesh could be used in the closure of emergency midline laparotomies in high-risk groups |
Grade A | A prophylactic mesh should be placed at the primary stoma operation |
Grade B | Extraperitoneal colostomy is more effective and safer for end colostomies compared to transperitoneal |
Grade B | The resorbable synthetic mesh has no advantage during emergency ostomy formation |
Chapter 31. NOTES and Single-Port Surgery: Is there currently any role in Ventral Hernia Repair today?
Davide Lomanto, R. Fortelny, Hrishikesh P. Salgaonkar
Level 4 | NOTES technique for ventral hernia repair is feasible providing improved cosmesis and possible reduction in port-site hernia in experimental groups |
Level 2b | Surgically prepped vaginal canal can be a sterile conduit for insertion of polypropylene mesh for transvaginal ventral hernia repair |