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Ventral Hernia Management: Expert Consensus Guided by Systematic Review.

Abstract：

OBJECTIVE:To achieve consensus on the best practices in the management of ventral hernias (VH). BACKGROUND:Management patterns for VH are heterogeneous, often with little supporting evidence or correlation with existing evidence. METHODS:A systematic review identified the highest level of evidence available for each topic. A panel of expert hernia-surgeons was assembled. Email questionnaires, evidence review, panel discussion, and iterative voting was performed. Consensus was when all experts agreed on a management strategy. RESULTS:Experts agreed that complications with VH repair (VHR) increase in obese patients (grade A), current smokers (grade A), and patients with glycosylated hemoglobin (HbA1C) ≥ 6.5% (grade B). Elective VHR was not recommended for patients with BMI ≥ 50 kg/m (grade C), current smokers (grade A), or patients with HbA1C ≥ 8.0% (grade B). Patients with BMI= 30-50 kg/m or HbA1C = 6.5-8.0% require individualized interventions to reduce surgical risk (grade C, grade B). Nonoperative management was considered to have a low-risk of short-term morbidity (grade C). Mesh reinforcement was recommended for repair of hernias ≥ 2 cm (grade A). There were several areas where high-quality data were limited, and no consensus could be reached, including mesh type, component separation technique, and management of complex patients. CONCLUSIONS:Although there was consensus, supported by grade A-C evidence, on patient selection, the safety of short-term nonoperative management, and mesh reinforcement, among experts; there was limited evidence and broad variability in practice patterns in all other areas of practice. The lack of strong evidence and expert consensus on these topics has identified gaps in knowledge where there is need of further evidence.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Liang MK,Holihan JL,Itani K,Alawadi ZM,Gonzalez JR,Askenasy EP,Ballecer C,Chong HS,Goldblatt MI,Greenberg JA,Harvin JA,Keith JN,Martindale RG,Orenstein S,Richmond B,Roth JS,Szotek P,Towfigh S,Tsuda S,Vaziri K,Berg

doi

10.1097/SLA.0000000000001701

subject

Has Abstract

pub_date

2017-01-01 00:00:00

pages

80-89

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-201701000-00015

journal_volume

265

pub_type

共识发展会议,杂志文章

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Ventral Hernia Management: Expert Consensus Guided by Systematic Review.