Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

Abstract

The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

“…These techniques must consequently be firstly taught and then mastered. Based on the guidelines [2][3][4][5][6][7][8][9][10][11][12][13][14], implementation of such a tailored approach is a prerequisite now for low-risk and effective abdominal wall surgery.…”

“…The most important argument for this recommendation is the increasing complexity of abdominal wall surgery due to new techniques, more difficult cases, a recognized tailored approach and an increasing public awareness which demands nothing short of optimal treatment results [1]. The rising complexity of abdominal wall surgery has led to the international hernia societies publishing several guidelines [2][3][4][5][6][7][8][9][10][11][12][13][14]. However, more work is required to define in the scientific literature the growing evolution and complex nature of contemporaneous abdominal wall surgery.…”

“…The guidelines to date take into account developments in abdominal wall surgery and issue evidence-based recommendations for the best possible contemporary practices in abdominal wall surgery [2][3][4][5][6][7][8][9][10][11][12][13][14]. The scope of these guidelines clearly provides information as to how complex abdominal wall surgery has now become and consideration of the myriad of technical details in abdominal wall surgery will inevitably help contribute to the preferred good outcomes [2][3][4][5][6][7][8][9][10][11][12][13][14]. Notwithstanding a clinician's relative experience with the use of a tailored approach for hernia repair, mastery of a single surgical technique is now recognized as possibly insufficient.…”

“…Notwithstanding a clinician's relative experience with the use of a tailored approach for hernia repair, mastery of a single surgical technique is now recognized as possibly insufficient. Therefore, several techniques must now be possibly taught, learned and mastered for each type of hernia to promote a better outcome with minimal morbidity to each individual patient [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

What is the outcome of the open IPOM versus sublay technique in the treatment of larger incisional hernias?: A propensity score-matched comparison of 9091 patients from the Herniamed Registry

“…Based on meta-analyses [5][6][7][8], registry data [9] and guidelines [10][11][12][13][14][15][16], laparoscopic IPOM can be recommended for repair of incisional hernia defects up to 8-10 cm. Compared with open mesh procedures, laparoscopic IPOM is associated with fewer surgical site occurrences and complication-related reoperations [5][6][7][8][9][10][11][12][13][14][15][16]. But for a defect size greater than 8-10 cm, the recurrence rate rises sharply following laparoscopic IPOM [10][11][12][13][14][15][16].…”