A systematic methodological review of reported perioperative variables, postoperative outcomes and hernia recurrence from randomised controlled trials of elective ventral hernia repair: clear definitions and standardised datasets are needed

Parker, Samuel G.; Wood, Chris; Butterworth, James; Boulton, Richard; Plumb, Andrew; Mallett, Susan; Halligan, Steve; Windsor, Alastair

doi:10.1007/s10029-017-1718-4

Cited by 32 publications

(34 citation statements)

References 75 publications

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“…Sixty-seven articles were from the primary literature, comprising 44 case series, 17 case reports, 4 retrospective database analyses [ 18 , 33 – 35 ], and 2 retrospective interventional studies [ 36 ] [ 30 ]. Ten articles were from the secondary literature comprising seven editorials, two systematic reviews [ 20 , 37 ] and one consensus questionnaire [ 11 ]. The primary literature reported a total of 1528 patients; 419 of these were retrospective database analyses.…”

Section: Resultsmentioning

confidence: 99%

What Exactly is Meant by “Loss of Domain” for Ventral Hernia? Systematic Review of Definitions

Parker

Halligan²,

Blackburn

et al. 2018

World j. surg.

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Large ventral hernias are a significant surgical challenge. "Loss of domain" (LOD) expresses the relationship between hernia and abdominal volume, and is used to predict operative difficulty and success. This systematic review assessed whether different definitions of LOD are used in the literature. The PubMed database was searched for articles reporting large hernia repairs that explicitly described LOD. Two reviewers screened citations and extracted data from selected articles, focusing on the definitions used for LOD, study demographics, study design, and reporting surgical specialty. One hundred and seven articles were identified, 93 full-texts examined, and 77 were included in the systematic review. Sixty-seven articles were from the primary literature, and 10 articles were from the secondary literature. Twenty-eight articles (36%) gave a written definition for loss of domain. These varied and divided into six broad groupings; four described the loss of the right of domain, six described abdominal strap muscle contraction, five described the "second abdomen", five describing large irreducible hernias. Six gave miscellaneous definitions. Two articles gave multiple definitions. Twenty articles (26%) gave volumetric definitions; eight used the Tanaka method [hernia sac volume (HSV)/abdominal cavity volume] and five used the Sabbagh method [(HSV)/total peritoneal volume]. The definitions used for loss of domain were not dependent on the reporting specialty. Our systematic review revealed that multiple definitions of loss of domain are being used. These vary and are not interchangeable. Expert consensus on this matter is necessary to standardise this important concept for hernia surgeons.

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Section: Resultsmentioning

confidence: 99%

What Exactly is Meant by “Loss of Domain” for Ventral Hernia? Systematic Review of Definitions

Parker

Halligan²,

Blackburn

et al. 2018

World j. surg.

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“…One systematic review of the prospective randomized studies and reviews in the treatment of ventral and incisional hernias found only a limited evidence base for determining the best treatment options for patients despite the large number of patients with ventral and incisional hernias and the high frequency of repair ( 28 ). Another analysis of the literature on elective surgery of ventral and incisional hernias identified inconsistencies in reporting of peri- and postoperative variables and poor definition of variables ( 29 ). A further problem is the pooling of primary ventral hernias and incisional hernias in many studies, meta-analyses and systematic reviews ( 30 – 33 ).…”

Section: Introductionmentioning

confidence: 99%

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Köckerling

Schug-Paß

Scheuerlein³

2018

Front. Surg.

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Introduction: There continues to be very little agreement among experts on the precise treatment strategy for incisional hernias. That is the conclusion drawn from the very limited scientific evidence available on the repair of incisional hernias. The present review now aims to critically assess the data available on the sublay/retro-rectus technique for repair of incisional hernia. Materials and Methods:A systematic search of the literature was performed in May 2018 using Medline, PubMed, and the Cochrane Library. This article is based on 77 publications.Results: The number of available RCTs that permit evaluation of the role of the sublay/retro-rectus technique in the repair of only incisional hernia is very small. The existing data suggest that the sublay/retro-rectus technique has disadvantages compared with the laparoscopic IPOM technique for repair of incisional hernia, but in that respect has advantages over all other open techniques. However, the few existing studies provide only a limited level of evidence for assessment purposes. Conclusion:Further RCTs based on a standardized technique are urgently needed for evaluation of the role of the sublay/retro-rectus incisional hernia repair technique.

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“…This threshold can be summed up in a grip factor characterizing each individual reconstruction [ 8 ]. Due to high recurrence rates and rising socioeconomic cost, ventral hernia repair requires better standardization [ 1 ]. Considering biomechanical stability as a prerequisite for a stable scar formation there is a need for mechanical testing of reconstructions [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…With the Kruskal-Wallis-test, the necessary increase is statistically significant (p = 0.00042). Most randomized controlled studies quote hernia dimensions as an inclusion criteria but fail to report the mesh sizes used in relation to the hernia size [ 1 ]. Hernia overlap not tailored to the diameter of the hernia orifice is recognized as a key determinant of hernia recurrence [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair

Kallinowski

Gutjahr

Vollmer

et al. 2019

Annals of Medicine and Surgery

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Background Increasing hernia sizes lead to higher recurrence rates after ventral hernia repair. A better grip might reduce the failure rates. Material and methods A biomechanical model delivering dynamic intermittent strain (DIS) was used to assess grip values at various hernia orifices. The model consists of a water-filled aluminium cylinder covered with tissues derived from pig bellies which are punched with a central defect varying in diameter. DIS was applied mimicking coughs lasting for up to 2 s with peak pressures between 180 and 220 mmHg and a plateau phase of 0.1 s. Ventral hernia repair was simulated with hernia meshes in the sublay position secured by tacks, glue or sutures as needed to achieve certain grip values. Grip was calculated taking into account the mesh: defect area ratio and the fixation strength. Data were assessed using non-parametric statistics. Results Using a mesh classified as highly stable upon DIS testing (DIS class A) a reduced overlap without fixation led to early slippage (p < 0.001). With the application of 16 fixation points, transmural sutures were better than tacks with Securestrap ® being better than Absorbatack ® (p < 0.001). Plotting the likelihood of a durable repair as a function of the calculated grip higher grip values were needed with increasing hernia diameter to achieve biomechanical stability. This is important for clinical work since the calculated grip values both from a registry and from published data tend to drop as hernia sizes increase indicating biomechanical instability. Conclusion The experimental work reported here demonstrates for the first time that higher grip values should be reached when repairing larger ventral hernias.

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A systematic methodological review of reported perioperative variables, postoperative outcomes and hernia recurrence from randomised controlled trials of elective ventral hernia repair: clear definitions and standardised datasets are needed

Abstract: VH RCTs report peri- and post-operative variables inconsistently, and with poor definitions. A standardised minimum dataset, including definitions of recurrence, is required.

Cited by 32 publications

References 75 publications

What Exactly is Meant by “Loss of Domain” for Ventral Hernia? Systematic Review of Definitions

What Exactly is Meant by “Loss of Domain” for Ventral Hernia? Systematic Review of Definitions

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair

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