The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery

Omar, Islam; Miller, Karl; Madhok, Brijesh; Amr, Bassem; Singhal, Rishi; Graham, Yitka; Pouwels, Sjaak; Hilal, Mohammad Abu; Aggarwal, Sandeep; Ahmed, Ibrar; Aminian, Ali; Ammori, Basil Jaser; Arulampalam, Tan; Awan, Altaf; Bhangu, Aneel; Brady, Richard; Brown, Wendy; Chand, Manish; Darzi, Ara; Gill, Talvinder; Goel, Ramen; Gopinath, Bussa; Henegouwen, Mark van Berge; Himpens, Jacques; Kerrigan, David; Luyer, Misha; Macutkiewicz, Christian; Mayol, Julio; Purkayastha, Sanjay; Rosenthal, Raúl J.; Shikora, Scott A.; Small, Peter; Smart, Neil; Taylor, Mark A.; Udwadia, Tehemton E.; Underwood, Tim; Viswanath, Yirupaiahgari Ks; Welch, Neil T.; Wexner, Steven D.; Wilson, Michael; Winter, D. C.; Mahawar, Kamal

doi:10.1016/j.ijsu.2022.106766

Cited by 7 publications

(4 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is generally accepted that closure of the umbilical trocar site, most midline trocar sites of 10 mm or more, and any port site that is enlarged for specimen extraction (this is a specific trocar site situation and is not discussed further) is good practice ( 18 ). An international consensus group had 86.8% agreement that closure of 15 mm ports in all patients was necessary ( 29 ). The closure of 10 mm and upwards (and also 8 mm in some robotic operations) trocar sites off the midline is less clear cut, with a broad spectrum of opinion from the “never close” to the “always close” surgeon ( 29 , 30 ).…”

Section: Resultsmentioning

confidence: 99%

“…An international consensus group had 86.8% agreement that closure of 15 mm ports in all patients was necessary ( 29 ). The closure of 10 mm and upwards (and also 8 mm in some robotic operations) trocar sites off the midline is less clear cut, with a broad spectrum of opinion from the “never close” to the “always close” surgeon ( 29 , 30 ). A retrospective cohort series after laparoscopic sleeve gastrectomy, suggested that closure of the trocar site reduced the TSH incidence by two thirds ( 31 ).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Thoughts on Trocar Site Hernia Prevention. A Narrative Review

Beaux¹,

East²

2022

J. Abdom. Wall Surg.

View full text Add to dashboard Cite

Background: Laparoscopic and robot-assisted surgery is now common place, and each trocar site is a potential incisional hernia site. A number of factors increase the risk of trocar site hernia (TSH) at any given trocar site. The aim of this paper is to explore the literature and identify the patients and the trocar sites at risk, which may allow target prevention strategies to minimise TSH.Methods: A pub med literature review was undertaken using the MeSH terms of “trocar” OR “port-site” AND “hernia.” No qualifying criteria were applied to this initial search. All abstracts were reviewed by the two authors to identify papers for full text review to inform this narrative review.Results: 961 abstracts were identified by the search. A reasonable quality systematic review was published in 2012, and 44 additional more recent publications were identified as informative. A number of patient factors, pre-operative, intra-operative and post-operative factors were identified as possibly or likely increasing the risk of TSH. Their careful management alone and more likely in combination may help reduce the incidence of TSH.Conclusion: Clinically symptomatic TSH is uncommon, in relation to the many trocars inserted every day for “keyhole” surgery, although it is a not uncommon hernia to repair in general surgical practice. There are patients inherently at risk of TSH, especially at the umbilical location. It is likely, that a multi-factored approach to surgery, will have a cumulative effect at reducing the overall risk of TSH at any trocar site, including choice of trocar type and size, method of insertion, events during the operation, and decisions around the need for fascial closure and how this is performed following trocar removal.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Thoughts on Trocar Site Hernia Prevention. A Narrative Review

Beaux¹,

East²

2022

J. Abdom. Wall Surg.

View full text Add to dashboard Cite

show abstract

“…The weaknesses of this exercise lie in the arbitrary choice of the members and the threshold of 70% for the consensus agreement. However, this threshold has been adopted in many previous Delphi consensus exercises in the surgical field [36,37].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The First Modified Delphi Consensus‐Building Exercise on Surgical Ward Rounds in the United Kingdom National Health Service

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background The ward round is an integral part of everyday surgical practice. It is a complex clinical activity that requires both sound clinical management and communication skills. This study reports the results of a consensusbuilding exercise on the common aspects of the general surgical ward rounds. Methods The consensus-building committee involving a range of stakeholders from 16 United Kingdom (UK) National Health Service trusts took part in this consensus exercise. The members discussed and suggested a series of statements concerning surgical ward round. An agreement of C 70% among members was regarded as a consensus. Results Thirty-two members voted on 60 statements. There was a consensus on fifty-nine statements after the first round of voting, and one statement was modified before it reached consensus in the second round. The statements covered nine sections: a preparation phase, team allocation, multidisciplinary approach to the ward round, structure of the round, teaching considerations, confidentiality and privacy, documentation, post-round arrangements, and weekend round. There was a consensus on spending time to prepare for the round, a consultant-led round, involvement of the nursing staff, an MDT round at the beginning and end of the week, a minimum of 5 min allocated to each patient, utilisation of a round checklist, afternoon virtual round, and a clear handover and plan for the weekend. ConclusionThe consensus committee achieved agreement on several aspects concerning the surgical ward rounds in the UK NHS. This should help improve the care of surgical patients in the UK.

show abstract

“…In general, small port sizes are less likely to be associated with TSH. Conversely, according to a recent international Delphi consensus, the panel provided strong recommendation for closure of all 15 mm port sites and advised considering fascial closure for 10-12 mm ports [63]. Additionally, they recommended against drain placement through ≥10 mm sites, because this practice increases the risk of TSH after removal of the drain [63].…”

Section: Abdominal Wall Hernia Complicating Metabolic Bariatric Surgerymentioning

confidence: 99%

Hernia as a Complication of Metabolic Bariatric Surgery

Pantelis,

Bhandari

2023

Hernia Updates and Approaches

View full text Add to dashboard Cite

Metabolic Bariatric Surgery (MBS) is increasingly gaining ground, given that it constitutes the most effective treatment of obesity and associated health problems, with enduring results and a well-documented safety profile. Nevertheless, certain issues may rise in the medium and long term. Among them, there is a heterogeneous group of complications under the umbrella term “post-bariatric hernia”, including internal hernias, abdominal wall hernias, and hiatal hernias. Internal hernias constitute the most studied category, but evidence on the other categories is not lacking. This chapter will attempt to cover diagnostic, treatment, and preventive aspects in the management of hernia post-MBS following a comprehensive, evidence-based approach. In brief, with regards to the prevention of internal hernias, suturing of all defects is strongly recommended for Roux-en-Y Gastric Bypass (RYGB), but the evidence is less clear when it comes to newer bypass procedures, such as One-Anastomosis/Mini Gastric Bypass (OAGB/MGB) and Single Anastomosis Duodenal-Ileal Bypass (SADI). As far as abdominal wall hernias are concerned, there is no clear evidence of the advantages of suture closure against non-closure. Finally, with respect to hiatal hernias post-MBS, the caveat rests in the documentation of de novo versus pre-existing hiatal hernia, which mandates meticulous preoperative evaluation of symptoms and potentially further endoscopic documentation.

show abstract

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery

Cited by 7 publications

References 26 publications

Thoughts on Trocar Site Hernia Prevention. A Narrative Review

Thoughts on Trocar Site Hernia Prevention. A Narrative Review

The First Modified Delphi Consensus‐Building Exercise on Surgical Ward Rounds in the United Kingdom National Health Service

Hernia as a Complication of Metabolic Bariatric Surgery

Contact Info

Product

Resources

About