EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

Abstract

Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.

Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society

“…In the WSES guideline 9 for emergency repair of hernias, it is recommended that synthetic mesh is used in clean or clean-contaminated procedures. In a contaminated field, a primary sutured repair is suggested for defects smaller than 3 cm; alternatively, biological mesh may be considered 9 . In this guideline, ventral hernias included both primary and incisional hernias.…”

“…The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) 7 published a guideline on laparoscopic ventral hernia repair in 2016. An expert-guided consensus for the management of all types of ventral hernias exists 8 , and the World Society of Emergency Surgery (WSES) 9 addressed emergency repairs of both primary ventral and incisional hernias. To date, no guideline has been published on the treatment of umbilical and epigastric hernias, specifically addressing both open and laparoscopic techniques.…”

European Hernia Society (EHS) guidance for the management of adult patients with a hernia during the COVID-19 pandemic

“…Quality of the available evidence: very low Analyzed in guidelines: HerniaSurge [3]; EHS and AHS guidelines on other primary ventral hernias [19]; EHS guidelines on Parastomal Hernia [20]…”

“…2. The need to take care of patients suffering COVID- 19 infection, both critically and non-critically ill. 3. The limited resources in terms of healthcare workers and medical equipment that may well be required to treat patients with COVID-19 infection.…”

The power of level-1 evidence in umbilical hernia repair: mesh repair is supported by strong evidence

“…To assist clinical decision making for individual cases, some guidance may be helpful. Therefore the American and European Hernia Society teamed up to review all available evidence and developed guidelines for the surgeons and patients in clinical decision making in case of an umbilical hernia under normal, but also under special circumstances [4,5]. After reviewing all available evidence, a strong recommendation could be formulated, being: it is recommended that mesh is used for repair of umbilical and epigastric hernias to reduce the recurrence rate.…”