Laparoscopic treatment of ventral hernias: the Italian national guidelines

Abstract

Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline’s recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline's strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).

Case Report: Abdominal Wall Reconstruction in a High-Risk Patient With Incisional Hernia and Complications From Oncological Treatment

“…The management of complex incisional hernias in high-risk patients poses a challenge, particularly when considering the use of mesh in the presence of increased risks of bleeding, infection, and impaired wound healing [ 3 ]. In our case, we chose to perform abdominal wall reconstruction using mesh-free technique by transposing the hernia sac [ 4 ].…”

“…Although the decision to omit mesh and drains in our patient’s abdominal wall reconstruction proved successful in terms of wound healing and absence of complications, it is important to acknowledge that each case should be evaluated individually. Factors such as the size and complexity of the hernia, the patient’s overall health status, and the surgeon’s expertise should be considered when taking into account mesh-free techniques and the omission of drains [ 3 , 9 ].…”

Ventral hernia repair in India: a Delphi consensus

“…In the univariable analysis, the laparoscopic approach showed an overall morbidity rate of 9.1% vs. 15.1% of the open approach (RR, 0.60; 95% CI 0.46-0.79). Abdominal wall complications (superficial and deep wound infections, and dehiscence) were 3.0% vs. 7.9% (RR, 0.38; 95% CI 0.24-0.60) [62].…”

Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications

“…Surgical mesh is a medical device that supports the repair of a hernia as it heals. The use of mesh decreases hernia recurrences and has thus become standard practice [9][10][11][12][13][14][15][16][17][18], and has even be considered prophylactically when closing an incision at the first laparotomy [19,20]. The vast majority of patients are greatly benefited by the use of mesh, and it would be hard, if not impossible, to practice hernia surgery currently without mesh except at specialized centers or in low resource settings.…”