Samuel G Parker1, Steve Halligan2, Mike K Liang3, Filip E Muysoms4, Gina L Adrales5, Adam Boutall6, Andrew C de Beaux7, Ulrich A Dietz8, Celia M Divino9, Mary T Hawn10, Todd B Heniford11, Joon P Hong12, Nabeel Ibrahim13, Kamal M F Itani14, Lars N Jorgensen15, Agneta Montgomery16, Salvador Morales-Conde17, Yohann Renard18, David L Sanders19, Neil J Smart20, Jared J Torkington21, Alastair C J Windsor22. 1. The Abdominal Wall Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK. samgparker@nhs.net. 2. UCL Centre for Medical Imaging, 2nd floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK. 3. Department of Surgery, McGovern Medical Center, University of Texas Health Science Center, 5656 Kelley Street, Houston, TX, 77026, USA. 4. Department of Surgery, Maria Middelares Hospital, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium. 5. Division of Minimally Invasive Surgery, The John Hopkins Hospital, 600 North Wolfe Street Blalock 618, Baltimore, MD, 21287, USA. 6. The Colorectal Unit, Groote Schuur Hospital, Main Road, Observatory, Cape Town, 7925, South Africa. 7. Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK. 8. Department of Visceral, Vascular and Thoracic Surgery, Kantonal Hospital of Olten, Baselstrasse 150, Olten, 4600, Switzerland. 9. Department of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, 10029, USA. 10. Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA, 94304, USA. 11. Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA. 12. Department of Plastic Surgery, Asan Medical Center, University of Ulsan, 88 Oympicro, 43gil Songpagu, Seoul, 05505, South Korea. 13. Department of General Surgery, Macquarie University Hospital, 3 Technology Pl, Macquarie University, Sydney, NSW, 2109, Australia. 14. Department of General Surgery, Veterans Affairs Boston Health Care System, Boston and Harvard Universities, 1400 VFW Parkway, West Roxbury, MA, 02132, USA. 15. Digestive Disease Center, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark. 16. Department of Surgery, Skane University Hospital Malmo, 202 05, Malmo, Sweden. 17. Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital ''Virgen del Rocio'', Betis-65, 1, 41010, Seville, Spain. 18. Department of General, Digestive and Endocrine Surgery, Robert-Debre´ University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France. 19. Department of General and Upper GI Surgery, North Devon, District Hospital, Raleigh Park, Barnstaple, Devon, EX31 4JB, UK. 20. Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, England, UK. 21. Department of Colorectal Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK. 22. The Abdominal Wall Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
Abstract
BACKGROUND: No standardized written or volumetric definition exists for 'loss of domain' (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri- and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons. METHODS: A Delphi study involving 20 internationally recognized abdominal wall reconstruction (AWR) surgeons was performed. Four written and two volumetric definitions of LOD were identified via systematic review. Panelists completed a questionnaire that suggested these definitions as standardized definitions of LOD. Consensus on a preferred term was pre-defined as achieved when selected by ≥80% of panelists. Terms scoring <20% were removed. RESULTS: Voting commenced August 2018 and was completed in January 2019. Written definition: During Round 1, two definitions were removed and seven new definitions were suggested, leaving nine definitions for consideration. For Round 2, panelists were asked to select all appealing definitions. Thereafter, common concepts were identified during analysis, from which the facilitators advanced a new written definition. This received 100% agreement in Round 3. Volumetric definition: Initially, panelists were evenly split, but consensus for the Sabbagh method was achieved. Panelists could not reach consensus regarding a threshold LOD value that would preclude surgery. CONCLUSIONS: Consensus for written and volumetric definitions of LOD was achieved from 20 internationally recognized AWR surgeons. Adoption of these definitions will help standardize the use of LOD for both clinical and academic activities.
BACKGROUND: No standardized written or volumetric definition exists for 'loss of domain' (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri- and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons. METHODS: A Delphi study involving 20 internationally recognized abdominal wall reconstruction (AWR) surgeons was performed. Four written and two volumetric definitions of LOD were identified via systematic review. Panelists completed a questionnaire that suggested these definitions as standardized definitions of LOD. Consensus on a preferred term was pre-defined as achieved when selected by ≥80% of panelists. Terms scoring <20% were removed. RESULTS: Voting commenced August 2018 and was completed in January 2019. Written definition: During Round 1, two definitions were removed and seven new definitions were suggested, leaving nine definitions for consideration. For Round 2, panelists were asked to select all appealing definitions. Thereafter, common concepts were identified during analysis, from which the facilitators advanced a new written definition. This received 100% agreement in Round 3. Volumetric definition: Initially, panelists were evenly split, but consensus for the Sabbagh method was achieved. Panelists could not reach consensus regarding a threshold LOD value that would preclude surgery. CONCLUSIONS: Consensus for written and volumetric definitions of LOD was achieved from 20 internationally recognized AWR surgeons. Adoption of these definitions will help standardize the use of LOD for both clinical and academic activities.
Authors: Arielle E Kanters; David M Krpata; Jeffrey A Blatnik; Yuri M Novitsky; Michael J Rosen Journal: J Am Coll Surg Date: 2012-09-19 Impact factor: 6.113
Authors: Hillary J Mull; Laura A Graham; Melanie S Morris; Amy K Rosen; Joshua S Richman; Jeffery Whittle; Edith Burns; Todd H Wagner; Laurel A Copeland; Tyler Wahl; Caroline Jones; Robert H Hollis; Kamal M F Itani; Mary T Hawn Journal: JAMA Surg Date: 2018-08-01 Impact factor: 14.766
Authors: Rebeccah B Baucom; Jenny M Ousley; Omobolanle O Oyefule; Melissa K Stewart; Michael D Holzman; Kenneth W Sharp; Benjamin K Poulose Journal: Am Surg Date: 2015-07 Impact factor: 0.688
Authors: K E Poruk; C W Hicks; J Trent Magruder; N Rodriguez-Unda; K K Burce; S C Azoury; P Cornell; C M Cooney; F E Eckhauser Journal: Hernia Date: 2016-12-18 Impact factor: 4.739
Authors: Karl Breuing; Charles E Butler; Stephen Ferzoco; Michael Franz; Charles S Hultman; Joshua F Kilbridge; Michael Rosen; Ronald P Silverman; Daniel Vargo Journal: Surgery Date: 2010-03-20 Impact factor: 3.982
Authors: K E Poruk; N Farrow; F Azar; K K Burce; C W Hicks; S C Azoury; P Cornell; C M Cooney; F E Eckhauser Journal: Hernia Date: 2016-10-26 Impact factor: 4.739
Authors: Frederik Helgstrand; Jacob Rosenberg; Henrik Kehlet; Lars N Jorgensen; Thue Bisgaard Journal: J Am Coll Surg Date: 2012-12-07 Impact factor: 6.113
Authors: F E Muysoms; M Miserez; F Berrevoet; G Campanelli; G G Champault; E Chelala; U A Dietz; H H Eker; I El Nakadi; P Hauters; M Hidalgo Pascual; A Hoeferlin; U Klinge; A Montgomery; R K J Simmermacher; M P Simons; M Smietański; C Sommeling; T Tollens; T Vierendeels; A Kingsnorth Journal: Hernia Date: 2009-06-03 Impact factor: 4.739
Authors: A Tashkandi; J Bueno-Lledó; J Durtette-Guzylack; A Cayeux; R Bukhari; R Rhaeim; J M Malinovski; R Kianmanesh; Y Renard Journal: Hernia Date: 2021-03-09 Impact factor: 4.739
Authors: Hani I Naga; Joseph A Mellia; Fortunay Diatta; Sammy Othman; Viren Patel; Jeffrey E Janis; B Todd Heniford; John P Fischer Journal: Plast Reconstr Surg Glob Open Date: 2020-12-16
Authors: D S G Scrimgeour; M Allan; S R Knight; B East; S Blackwell; N Dames; L Laidlaw; D Light; L Horgan; N J Smart; A de Beaux; M S J Wilson Journal: Hernia Date: 2021-10-31 Impact factor: 2.920