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Surgical Endoscopy

, Volume 29, Issue 9, pp 2463–2484 | Cite as

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

  • Gianfranco Silecchia
  • Fabio Cesare CampanileEmail author
  • Luis Sanchez
  • Graziano Ceccarelli
  • Armando Antinori
  • Luca Ansaloni
  • Stefano Olmi
  • Giovanni Carlo Ferrari
  • Diego Cuccurullo
  • Paolo Baccari
  • Ferdinando Agresta
  • Nereo Vettoretto
  • Micaela Piccoli
Guidelines

Abstract

Background

The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues.

Methods

The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. “The Oxford 2011 Levels of Evidence”) was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group.

Results and Conclusions

The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.

Keywords

Abdominal Bariatric Hernia Obesity Ultrasonography Clinical papers Clinical trials Clinical research 

Notes

Acknowledgments

We gratefully acknowledge the contributions of Dr Salvator Morales Conde and Davide Lomanto, as external reviewers, designed, respectively, by the European Hernia Society and the European Association for Endoscopic Surgery. We are particularly grateful to Dr Marina Davoli (Director of Department of Epidemiology of SSR Lazio) and Dr. Michela Cinquini (Istituto Ricerche Farmacologiche Mario Negri—Head of the Unit “Methodology of Systematic Revision and Guideline Production”), epidemiologists, who reviewed the methodological aspects and supported the Panel during all the steps of the consensus conference. Finally, Dr Antonio Corcione, designed by the Italian Society of Anesthesia (SIAARTI), who reviewed the aspects related to anesthesia. Thanks also to Dr Luigi Di Maggio, webmaster of the S.I.C.E. Web site, for his helpfulness and professional support in adapting the S.I.C.E. Forum to the needs of the consensus. We also express our gratitude to all the Presidents of the Scientific Societies that endorsed the consensus. The consensus conference was endorsed by: SICE, ITALIAN CHAPTER EUROPEAN HERNIA SOCIETY, SIC, ACOI, EAES, EHS, SIAARTI

Disclosures

Authors Gianfranco Silecchia, Fabio Cesare Campanile, Luis Sanchez, Graziano Ceccarelli, Armando Antinori, Luca Ansaloni, Stefano Olmi, Giovanni Carlo Ferrari, Diego Cuccurullo, Paolo Baccari, Ferdinando Agresta, Nereo Vettoretto, and Micaela Piccoli declare that they have no conflict of interest to disclose.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Gianfranco Silecchia
    • 1
  • Fabio Cesare Campanile
    • 2
    Email author
  • Luis Sanchez
    • 3
  • Graziano Ceccarelli
    • 4
  • Armando Antinori
    • 5
  • Luca Ansaloni
    • 6
  • Stefano Olmi
    • 7
  • Giovanni Carlo Ferrari
    • 8
  • Diego Cuccurullo
    • 9
  • Paolo Baccari
    • 10
  • Ferdinando Agresta
    • 11
  • Nereo Vettoretto
    • 12
  • Micaela Piccoli
    • 13
  1. 1.Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and BiotechnologySapienza University of RomeLatinaItaly
  2. 2.Division of General SurgeryOspedale San Giovanni Decollato Andosilla, ASL VTCivita CastellanaItaly
  3. 3.Division of Oncologic Surgery, Department of OncologyAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  4. 4.Division of General SurgeryOspedale di SpoletoSpoletoItaly
  5. 5.Department of SurgeryCatholic University of RomeRomeItaly
  6. 6.Division of General Surgery IPapa Giovanni XXIII HospitalBergamoItaly
  7. 7.Division of General and Oncologic Surgery, Advanced Laparoscopy CenterPoliclinico San MarcoZingoniaItaly
  8. 8.Division of General, Oncologic and Mini-Invasive SurgeryA.O. Ospedale Niguarda Cà GrandaMilanItaly
  9. 9.Division of General, Laparoscopic and Robotic SurgeryAORN dei Colli Ospedale MonaldiNaplesItaly
  10. 10.Division of General SurgerySanta Maria della Misericordia HospitalPerugiaItaly
  11. 11.Department of General SurgeryULSS19 del VenetoAdriaItaly
  12. 12.Laparoscopic Surgical UnitM.Mellini HospitalChiariItaly
  13. 13.Department of SurgeryNOCSAE (Nuovo Ospedale Civile Sant’Agostino Estense)BaggiovaraItaly

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