Salvador Morales-Conde1,2, Frederick Berrevoet3, Lars Nannestad Jorgensen4, Domenico Marchi5, Pablo Ortega-Deballon6, Alistair Windsor7. 1. Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Seville, Spain. smoralesc@gmail.com. 2. Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazon, Seville, Spain. smoralesc@gmail.com. 3. Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium. 4. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark. 5. Colorectal Surgery Unit, Department of Surgery, Campus Bio-Medico University of Rome, Rome, Italy. 6. Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France. 7. Consultant Surgeon, HCA Healthcare UK, London Digestive Centre, London, UK.
Abstract
BACKGROUND: Standard synthetic and biologic meshes, often used in hernia repair, have commonly been used and each have their strengths but associated drawbacks. Long-term biosynthetic absorbable (LTBA) mesh has been developed to combine the strengths of synthetic and biologic meshes without the associated weaknesses. As a newer type of mesh, the supporting evidence base is still growing, and their optimum use has yet to be defined. This consensus was initiated to provide insight into those situations where a LTBA might be considered the Standard of Care in ventral hernia repair grades 2-3 (original classification, 2010) of the Ventral Hernia Working Group. METHODS: A steering group of expert surgeons identified 35 statements, based around the evidence supporting LTBA, surgical technique, patients type most suitable for LTBA, risk-benefit of LTBA, patient and surgeon considerations, LTBA value. Surgeons involved in hernia repair received an online survey to assess consensus with these statements. Consensus was defined as high if ≥ 70% and very high if ≥ 90% of respondents agreed. Statements that had not achieved consensus agreement were revised and these were then issued for a subsequent round. Finally, 34 statements were included. RESULTS: Two hundred fifty-five surgeons were involved. Fourteen statements (41%) achieved very high consensus, 24 achieved consensuses (≥ 70-< 90%), whilst one (3%) just failed to achieve consensus with an agreement score of 69%. CONCLUSIONS: Expert consensus opinion about the use of LTBA for hernia (Grades 2-3) as the Standard of Care was achieved. Based on the consensus scores, the steering group derived eleven keys.
BACKGROUND: Standard synthetic and biologic meshes, often used in hernia repair, have commonly been used and each have their strengths but associated drawbacks. Long-term biosynthetic absorbable (LTBA) mesh has been developed to combine the strengths of synthetic and biologic meshes without the associated weaknesses. As a newer type of mesh, the supporting evidence base is still growing, and their optimum use has yet to be defined. This consensus was initiated to provide insight into those situations where a LTBA might be considered the Standard of Care in ventral hernia repair grades 2-3 (original classification, 2010) of the Ventral Hernia Working Group. METHODS: A steering group of expert surgeons identified 35 statements, based around the evidence supporting LTBA, surgical technique, patients type most suitable for LTBA, risk-benefit of LTBA, patient and surgeon considerations, LTBA value. Surgeons involved in hernia repair received an online survey to assess consensus with these statements. Consensus was defined as high if ≥ 70% and very high if ≥ 90% of respondents agreed. Statements that had not achieved consensus agreement were revised and these were then issued for a subsequent round. Finally, 34 statements were included. RESULTS: Two hundred fifty-five surgeons were involved. Fourteen statements (41%) achieved very high consensus, 24 achieved consensuses (≥ 70-< 90%), whilst one (3%) just failed to achieve consensus with an agreement score of 69%. CONCLUSIONS: Expert consensus opinion about the use of LTBA for hernia (Grades 2-3) as the Standard of Care was achieved. Based on the consensus scores, the steering group derived eleven keys.
Authors: R W Luijendijk; W C Hop; M P van den Tol; D C de Lange; M M Braaksma; J N IJzermans; R U Boelhouwer; B C de Vries; M K Salu; J C Wereldsma; C M Bruijninckx; J Jeekel Journal: N Engl J Med Date: 2000-08-10 Impact factor: 91.245
Authors: Christopher W Snyder; Laura A Graham; Stephen H Gray; Catherine C Vick; Mary T Hawn Journal: J Am Coll Surg Date: 2011-04 Impact factor: 6.113
Authors: John Scott Roth; Gary J Anthone; Don J Selzer; Benjamin K Poulose; James G Bittner; William W Hope; Raymond M Dunn; Robert G Martindale; Matthew I Goldblatt; David B Earle; John R Romanelli; Gregory J Mancini; Jacob A Greenberg; John G Linn; Eduardo Parra-Davila; Bryan J Sandler; Corey R Deeken; Guy R Voeller Journal: Surg Endosc Date: 2017-10-23 Impact factor: 4.584