Ventral hernia management: Expert consensus guided by systematic review

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 VaziriDavid H. Berger

Research output: Contribution to journalReview article

91 Scopus citations

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/m2 (grade C), current smokers (grade A), or patients with HbA1C ≥8.0% (grade B). Patients with BMI=30-50 kg/m2 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.

Original languageEnglish (US)
Pages (from-to)80-89
Number of pages10
JournalAnnals of surgery
Volume265
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • Consensus
  • Guidelines
  • Incisional hernia
  • Umbilical hernia
  • Ventral hernia

ASJC Scopus subject areas

  • Surgery

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    Liang, M. K., Holihan, J. L., Itani, K., Alawadi, Z. M., Gonzalez, J. R. F., Askenasy, E. P., Ballecer, C., Chong, H. S., Goldblatt, M. I., Greenberg, J. A., Harvin, J. A., Keith, J. N., Martindale, R. G., Orenstein, S., Richmond, B., Roth, J. S., Szotek, P., Towfigh, S., Tsuda, S., ... Berger, D. H. (2017). Ventral hernia management: Expert consensus guided by systematic review. Annals of surgery, 265(1), 80-89. https://doi.org/10.1097/SLA.0000000000001701