L Knaapen1, O Buyne1, N Slater2, B Matthews3, H Goor1, C Rosman1. 1. Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. 2. Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. 3. Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
Abstract
BACKGROUND: The surgical treatment of patients with complex ventral hernias is challenging. The aim of this study was to present an international overview of expert opinions on current practice. METHODS: A survey questionnaire was designed to investigate preoperative risk management, surgical approach and mesh choice in patients undergoing complex hernias repair, and treatment strategies for infected meshes. Geographical location of practice, experience and annual volumes of the surgeons were compared. RESULTS: Of 408 surgeons, 234 (57.4 per cent) were practising in the USA, 116 (28.4 per cent) in Europe, and 58 (14.2 per cent) in other countries. Some 412 of 418 surgeons (98.6 per cent) performed open repair and 322 of 416 (77.4 per cent) performed laparoscopic repair. Most recommended preoperative work-up/lifestyle changes such as smoking cessation (319 of 398, 80.2 per cent) and weight loss (254 of 399, 63.7 per cent), but the consequences of these strategies varied. American surgeons and less experienced surgeons were stricter. Antibiotics were given at least 1 h before surgery by 295 of 414 respondents (71.3 per cent). Synthetic and biological meshes were used equally in contaminated primary hernia repair, whereas for recurrent hernia repair synthetic mesh was used in a clean environment and biological or no mesh in a contaminated environment. American surgeons and surgeons with less experience preferred biological mesh in contaminated environments significantly more often. Percutaneous drainage and antibiotics were the first steps recommended in treating mesh infection. In the presence of sepsis, most surgeons favoured synthetic mesh explantation and further repair with biological mesh. CONCLUSION: There remains a paucity of good-quality evidence in dealing with these hernias, leading to variations in management. Patient optimization and issues related to mesh choice and infections require well designed prospective studies.
BACKGROUND: The surgical treatment of patients with complex ventral hernias is challenging. The aim of this study was to present an international overview of expert opinions on current practice. METHODS: A survey questionnaire was designed to investigate preoperative risk management, surgical approach and mesh choice in patients undergoing complex hernias repair, and treatment strategies for infected meshes. Geographical location of practice, experience and annual volumes of the surgeons were compared. RESULTS: Of 408 surgeons, 234 (57.4 per cent) were practising in the USA, 116 (28.4 per cent) in Europe, and 58 (14.2 per cent) in other countries. Some 412 of 418 surgeons (98.6 per cent) performed open repair and 322 of 416 (77.4 per cent) performed laparoscopic repair. Most recommended preoperative work-up/lifestyle changes such as smoking cessation (319 of 398, 80.2 per cent) and weight loss (254 of 399, 63.7 per cent), but the consequences of these strategies varied. American surgeons and less experienced surgeons were stricter. Antibiotics were given at least 1 h before surgery by 295 of 414 respondents (71.3 per cent). Synthetic and biological meshes were used equally in contaminated primary hernia repair, whereas for recurrent hernia repair synthetic mesh was used in a clean environment and biological or no mesh in a contaminated environment. American surgeons and surgeons with less experience preferred biological mesh in contaminated environments significantly more often. Percutaneous drainage and antibiotics were the first steps recommended in treating mesh infection. In the presence of sepsis, most surgeons favoured synthetic mesh explantation and further repair with biological mesh. CONCLUSION: There remains a paucity of good-quality evidence in dealing with these hernias, leading to variations in management. Patient optimization and issues related to mesh choice and infections require well designed prospective studies.
Authors: Mike K Liang; Julie L Holihan; Kamal Itani; Zeinab M Alawadi; Juan R Flores Gonzalez; Erik P Askenasy; Conrad Ballecer; Hui Sen Chong; Matthew I Goldblatt; Jacob A Greenberg; John A Harvin; Jerrod N Keith; Robert G Martindale; Sean Orenstein; Bryan Richmond; John Scott Roth; Paul Szotek; Shirin Towfigh; Shawn Tsuda; Khashayar Vaziri; David H Berger Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: Mary T Hawn; Christopher W Snyder; Laura A Graham; Stephen H Gray; Kelly R Finan; Catherine C Vick Journal: J Am Coll Surg Date: 2010-05 Impact factor: 6.113
Authors: N J Slater; A Montgomery; F Berrevoet; A M Carbonell; A Chang; M Franklin; K W Kercher; B J Lammers; E Parra-Davilla; S Roll; S Towfigh; E van Geffen; J Conze; H van Goor Journal: Hernia Date: 2013-10-23 Impact factor: 4.739
Authors: Luise I M Pernar; Claire H Pernar; Bryan V Dieffenbach; David C Brooks; Douglas S Smink; Ali Tavakkoli Journal: Surg Endosc Date: 2016-07-20 Impact factor: 4.584
Authors: Marjolein Lugtenberg; Jako S Burgers; Casper F Besters; Dolly Han; Gert P Westert Journal: BMC Fam Pract Date: 2011-09-22 Impact factor: 2.497