S G Parker1, S Halligan2, M K Liang3, F E Muysoms4, G L Adrales5, A Boutall6, A C de Beaux7, U A Dietz8, C M Divino9, M T Hawn10, T B Heniford11, J P Hong12, N Ibrahim13, K M F Itani14, L N Jorgensen15, A Montgomery16, S Morales-Conde17, Y Renard18, D L Sanders19, N J Smart20, J J Torkington21, A C J Windsor1. 1. Abdominal Wall Unit, University College London Hospital, London, UK. 2. UCL Centre for Medical Imaging, London, UK. 3. Department of Surgery, McGovern Medical Center, University of Texas Health Science Center, Houston, Texas, USA. 4. Department of Surgery, Maria Middelares Hospital, Ghent, Belgium. 5. Division of Minimally Invasive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. 6. Colorectal Unit, Groote Schuur Hospital, Cape Town, South Africa. 7. Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK. 8. Department of Visceral, Vascular and Thoracic Surgery, Kantonal Hospital of Olten, Olten, Switzerland. 9. Department of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, USA. 10. Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA. 11. Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA. 12. Department of Plastic Surgery, Asan Medical Centre, University of Ulsan, Seoul, South Korea. 13. Department of General Surgery, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia. 14. Department of General Surgery, Veterans Affairs Boston Health Care System, Boston and Harvard Universities, West Roxbury, Massachusetts, USA. 15. Digestive Disease Centre, Bispebjerg University Hospital, Copenhagen, Denmark. 16. Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden. 17. Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital 'Virgen del Rocio', Seville, Spain. 18. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims Cedex, France. 19. Department of General and Upper Gastrointestinal Surgery, North Devon District Hospital, Barnstaple, UK. 20. Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Exeter, UK. 21. Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK.
Abstract
BACKGROUND: Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including 'inlay', 'sublay' and 'underlay', can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. METHODS: A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed. RESULTS: Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms 'onlay', 'inlay', 'preperitoneal' and 'intraperitoneal'. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for 'anterectus', 'interoblique', 'retro-oblique' and 'retromuscular'. Default consensus was achieved for the 'retrorectus' and 'transversalis fascial' planes. CONCLUSION: Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.
BACKGROUND: Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including 'inlay', 'sublay' and 'underlay', can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. METHODS: A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed. RESULTS: Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms 'onlay', 'inlay', 'preperitoneal' and 'intraperitoneal'. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for 'anterectus', 'interoblique', 'retro-oblique' and 'retromuscular'. Default consensus was achieved for the 'retrorectus' and 'transversalis fascial' planes. CONCLUSION: Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.
Authors: A N Christopher; M P Morris; V Patel; J A Mellia; C Fowler; C A Messa; R B Broach; J P Fischer Journal: Hernia Date: 2021-04-27 Impact factor: 4.739
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Authors: A Aiolfi; M Cavalli; F Gambero; E Mini; F Lombardo; L Gordini; G Bonitta; P G Bruni; D Bona; G Campanelli Journal: Hernia Date: 2022-08-03 Impact factor: 2.920
Authors: A Bravo-Salva; N Argudo-Aguirre; A M González-Castillo; E Membrilla-Fernandez; J J Sancho-Insenser; L Grande-Posa; M Pera-Román; J A Pereira-Rodríguez Journal: BMC Surg Date: 2021-05-18 Impact factor: 2.102