An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique

Dietz, Ulrich; Hamelmann, W.; Winkler, Martin Sebastian; Debus, Eike Sebastian; Malafaia, Osvaldo; Czeczko, Nicolau Gregori; Thiede, A.; Kuhfuß, I.

doi:10.1016/j.bjps.2006.10.010

Cited by 67 publications

(35 citation statements)

References 38 publications

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“…The reports in the literature range from 1% to 50% [2,9]. The recurrence rate is correlated to the follow-up time and there are only few high-quality studies with a long-term follow-up.…”

Section: Reviewmentioning

confidence: 99%

“…For example, an EHS expert meeting proposed a parastomal hernia classification [22]. In general, the consideration of all relevant risk factors would be desirable [2,3,18,22]. In reality, this may be difficult to implement completely in one classification system because of the above mentioned complex multifactorial scenario.…”

Section: Incisional Hernia Classifications In Generalmentioning

confidence: 99%

“…The classification suggested by Hadeed et al is very simple but with respect to the required detailed treatment planning and the aim of further standardized treatment algorithms it may not be sufficient in clinical practice [25]. Grade of Reducibility [11,13,16] Symptomatology [13,16] Specific localization (e. g. lumbar hernia, Pfannenstiel incision, subcostal incision, extended sternotomy incision) [16] Eventration in upright and supine position [11] Stability of the adjacent abdominal wall [11] Patient's Body Type (subcostal angle, attenuated muscles, voluminous abdomen) [2,3] Palpability of the gap edges [16] Hernia content [16] More planning regarding port placement, mesh fixation and/or colon mobilisation is required [16] Multiple scarred abdomen [16] Multiple previous incisions [16] Presenting as acute obstruction [16] Ratio Abdominal wall surface/wall defect surface [15] Risk factors for recurrence [2,3] Number of hernia gaps [11] Differentiation primary ventral hernia/incisional hernia [14] Slater's classification has the advantage of listing almost all factors that are relevant for a complex hernia. It appears, however, to be a problem, that even one risk factor for impaired wound healing (obesity, diabetes, steroid use, tobacco smoking, old age or poor nutritional status/albumin < 30 g/dl) is sufficient to define a "minor" class complex hernia.…”

Section: Characteristics and Classifications Of Complex Incisional Hementioning

confidence: 99%

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Complex Incisional Hernias

Scheuerlein¹,

Settmacher²,

Lenschow³

et al. 2016

Arch Clin Gastroenterol

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“…The reports in the literature range from 1% to 50% [2,9]. The recurrence rate is correlated to the follow-up time and there are only few high-quality studies with a long-term follow-up.…”

Section: Reviewmentioning

confidence: 99%

Section: Incisional Hernia Classifications In Generalmentioning

confidence: 99%

Section: Characteristics and Classifications Of Complex Incisional Hementioning

confidence: 99%

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Complex Incisional Hernias

Scheuerlein¹,

Settmacher²,

Lenschow³

et al. 2016

Arch Clin Gastroenterol

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“…The advent of prosthetic materials, meshes of the most diverse compositions, was key in improving the technical outcomes of the surgical repair of congenital or acquired abdominal wall defects. Its utilization, compared with the simple rhaphy of the aponeurotic defect, reduced the recurrence rates of hernias considerably [2][3][4][5][6][7][8] . The polypropylene mesh is the most commonly used material [2][3][4]6,[9][10][11][12] .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

“…Its utilization, compared with the simple rhaphy of the aponeurotic defect, reduced the recurrence rates of hernias considerably [2][3][4][5][6][7][8] . The polypropylene mesh is the most commonly used material [2][3][4]6,[9][10][11][12] . The intra-abdominal use of meshes, however, has restricted indications, since their intraperitoneal placement brings forth complications as it may be associated with the formation of adhesions, enterocutaneous fistulae 6,7,[13][14][15][16][17] and Araújo …”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Reparo intraperitoneal de defeitos da parede ventral do abdome com telas de poliéster com colágeno e polipropileno com ácido poliglicólico

Araújo

Czeczko

Ribas-Filho

et al. 2009

Rev. Col. Bras. Cir.

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OBJETIVO: Avaliar a incorporação de telas de poliéster revestido em uma de suas faces por colágeno (Parietex, Covidien) e polipropileno recoberto por ácido poliglicólico (Optilene Mesh Elastic e Safil, BBD Aesculap) no reparo de defeitos da parede ventral de coelhos avaliando a cicatrização no aspecto macroscópico, o depósito de colágeno e a imunomarcação tecidual pelos anticorpos MMP-1, MMP-8 e MMP-13. MÉTODOS: Utilizaram-se 16 coelhos, divididos em dois grupos de oito animais, avaliados após eutanásia após 30 e 60 dias de pós-operatório. Os animais foram submetidos à realização de dois defeitos simétricos na parede ventral do abdome, à direita e esquerda da linha alba, que compreendendo todos os folhetos musculares e o peritônio. O reparo dos defeitos foi realizado mediante implante intraperitoneal de dois modelos diferentes de telas. Utilizou-se a tela de poliéster revestido com camada protetora de colágeno (grupo controle) e a tela de polipropilene revestido com malha de ácido poliglicólico (manufaturacao própria, grupo de experimentacao). A avaliacao constou de aspectos clínicos, achados macroscópicos, análise dos colágenos tipos I/III e avaliação imunoistoquímica de metaloproteinases. RESULTADOS: Os resultados da avaliacao clínica e os parâmetros macroscópicos foram semelhantes entre os grupos. 50% dos animais do grupo Parietex tiveram ausência de aderencias intraperitoneais a no 30° dia de pós-operatrório. Em ambos os grupos observou-se reducao das aderências entre o 30° e o 60° dias de pós-operatório, contudo sem diferenca estatística. As aderências observadas foram classificadas principalmente de frouxas. Nao se observou a ocorrencia de complicacoes envolvendo vísceras intraabdominais. No Grupo Parietex houve a ocorrência de formacao de ulceracao da pele que recobria a tela em quatro animais, em comparacao com um no grupo de experimentacao. No Grupo Parietex foi observada uma insuficiencia de reparo após 60 dias. Quanto ao depósito do colágeno tipos I e III, nao houve diferenca significativa entre os grupos. Os resultados da imunoistoquímica referentes aos anticorpos MMP-1 e MMP-8 também não demonstraram diferença significativa entre as telas. CONCLUSÃO: As duas telas pesquisadas obtiveram resultados semelhantes tanto nos aspectos macro como nos microscópicos, podendo ser consideradas semelhantes quanto ao reparo de defeitos cirúrgicos da parede ventral do abdome em coelhos.

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International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair

Parker

Halligan²,

Liang

et al. 2019

British Journal of Surgery

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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.

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An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique

Cited by 67 publications

References 38 publications

Complex Incisional Hernias

Complex Incisional Hernias

Reparo intraperitoneal de defeitos da parede ventral do abdome com telas de poliéster com colágeno e polipropileno com ácido poliglicólico

International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair

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