Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement
File(s)
Published version
Author(s)
Kontovounisios, Christos
Type
Journal Article
Abstract
Background The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per
cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe.
Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection,
management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients
tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious
cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in
perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide
a clear benchmark of care for the preoperative assessment and perioperative optimization of patients
undergoing AWR.
Methods
The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirtytwo hernia surgeons from recognized hernia societies globally took part. The process included two
rounds of anonymous web-based voting with response analysis and formal feedback, concluding with
a live round of voting followed by discussion at an international conference. Consensus for a strong
recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per
cent agreement.
Results
Consensus was obtained on 52 statements including surgical assessment, preoperative assessment,
perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment.
Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement.
Conclusion
Clear consensus recommendations from a global group of experts in the AWR field are presented in
this study. These should be used as a baseline for surgeons and centres managing abdominal wall
hernias and performing complex AWR.
TOC summary: The Delphi method was used to provide consensus statements for preoperative
assessment and perioperative optimization of patients with complex abdominal wall hernias. Clear
recommendations are provided as a baseline for surgeons and centres managing complex abdominal
wall hernias.
cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe.
Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection,
management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients
tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious
cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in
perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide
a clear benchmark of care for the preoperative assessment and perioperative optimization of patients
undergoing AWR.
Methods
The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirtytwo hernia surgeons from recognized hernia societies globally took part. The process included two
rounds of anonymous web-based voting with response analysis and formal feedback, concluding with
a live round of voting followed by discussion at an international conference. Consensus for a strong
recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per
cent agreement.
Results
Consensus was obtained on 52 statements including surgical assessment, preoperative assessment,
perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment.
Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement.
Conclusion
Clear consensus recommendations from a global group of experts in the AWR field are presented in
this study. These should be used as a baseline for surgeons and centres managing abdominal wall
hernias and performing complex AWR.
TOC summary: The Delphi method was used to provide consensus statements for preoperative
assessment and perioperative optimization of patients with complex abdominal wall hernias. Clear
recommendations are provided as a baseline for surgeons and centres managing complex abdominal
wall hernias.
Date Issued
2021-10
Date Acceptance
2021-08-03
Citation
BJS Open, 2021, 5 (5), pp.1-7
ISSN
2474-9842
Publisher
Oxford University Press
Start Page
1
End Page
7
Journal / Book Title
BJS Open
Volume
5
Issue
5
Copyright Statement
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
License URL
Identifier
https://academic.oup.com/bjsopen/article/5/5/zrab082/6375607
Subjects
AWR Europe Collaborative
Publication Status
Published
Date Publish Online
2021-09-27