Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))—Part A

Abstract

In 2014, the International Endohernia Society (IEHS) published the first international "Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias." Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques-minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

“…Finally, the extent of separation must exceed the defect by at least 5 cm. In our study, the association between the mesh area and defect size area was according to the guidelines for the prevention of a recurrence, which was far more than 16:1 [23,24].…”

Endo‐laparoscopic inguinal hernia repair: What is its role?

“…The International Endohernia Society guidelines concluded that TAPP had longer operative times and longer hospital stays than TEP, but they noted that TEP has more intraoperative and postoperative complications. These guidelines also found both TAPP and TEP to be an acceptable treatment option for inguinal hernia repair .…”

The reality of general surgery training and increased complexity of abdominal wall hernia 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].…”