Ventral hernia repair in India: a Delphi consensus.

IF 2.6 2区医学 Q1 SURGERY Hernia Pub Date : 2024-10-01 Epub Date: 2024-05-09 DOI:10.1007/s10029-024-03062-4

P Chowbey, R Wadhawan, D Subramanian, D Bhandarkar, J Gandhi, K L Kumari, M Baijal, M Khetan, M S Kathalagiri, P Khandelwal, P Lal, P Dasgupta, P Balachandran, S Dave, S J Baig, V Soni

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Abstract

Purpose: While research on inguinal hernias is well-documented, ventral/incisional hernias still require investigation. In India, opinions on laparoscopic ventral hernia repair (LVHR) techniques are contested. The current consensus aims to standardize LVHR practice and identify gaps and unfulfilled demands that compromise patient safety and therapeutic outcomes.

Methods: Using the modified Delphi technique, panel of 14 experts (general surgeons) came to a consensus. Two rounds of consensus were conducted online. An advisory board meeting was held for the third round, wherein survey results were discussed and the final statements were decided with supporting clinical evidence.

Results: Experts recommended intraperitoneal onlay mesh (IPOM) plus/trans-abdominal retromuscular/extended totally extraperitoneal/mini- or less-open sublay operation/transabdominal preperitoneal/trans-abdominal partial extra-peritoneal/subcutaneous onlay laparoscopic approach/laparoscopic intracorporeal rectus aponeuroplasty as valid minimal access surgery (MAS) options for ventral hernia (VH). Intraperitoneal repair technique is the preferred MAS procedure for primary umbilical hernia < 4 cm without diastasis; incisional hernia in the presence of a vertical single midline incision; symptomatic hernia, BMI > 40 kg/m², and defect up to 4 cm; and for MAS VH surgery with grade 3/4 American Society of Anaesthesiologists. IPOM plus is the preferred MAS procedure for midline incisional hernia of width < 4 cm in patients with a previous laparotomy. Extraperitoneal repair technique is the preferred MAS procedure for L3 hernia < 4 cm; midline hernias < 4 cm with diastasis; and M5 hernia.

Conclusion: The consensus statements will help standardize LVHR practices, improve decision-making, and provide guidance on MAS in VHR in the Indian scenario.

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印度腹股沟疝修补术：德尔菲共识。

目的：虽然对腹股沟疝的研究已经有了充分的记录，但腹股沟疝/切口疝仍然需要研究。在印度，关于腹腔镜腹股沟疝修补术（LVHR）的观点存在争议。目前的共识旨在规范腹腔镜腹股沟疝修补术的实践，并找出差距和未满足的要求，这些都会影响患者的安全和治疗效果：方法：使用改良德尔菲技术，由 14 位专家（普通外科医生）组成的小组达成共识。在网上进行了两轮共识讨论。第三轮召开顾问委员会会议，讨论调查结果，并在有临床证据支持的情况下确定最终声明：结果：专家建议腹膜内铺设网片（IPOM）加/经腹膜后肌层/腹膜外全腹膜延伸/次腹膜下或少开腹手术/经腹膜前/经腹膜外部分/皮下铺设腹腔镜方法/腹腔镜体腔内直肌腱膜成形术是腹股沟疝（VH）的有效微创手术（MAS）选择。腹膜内修补术是原发性脐疝 40 kg/m2、缺损达 4 cm 的首选 MAS 手术，也是美国麻醉医师协会 3/4 级腹股沟疝手术的首选 MAS 手术。对于中线切口宽度的疝气，IPOM plus 是首选的 MAS 手术方法：这些共识声明将有助于规范 LVHR 实践，改善决策，并为印度情况下的 VHR MAS 提供指导。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.