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META Score: An International Consensus Scoring System on Mesh-Tissue Adhesions

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Abstract

Background

Currently, the lack of consensus on postoperative mesh-tissue adhesion scoring leads to incomparable scientific results. The aim of this study was to develop an adhesion score recognized by experts in the field of hernia surgery.

Methods

Authors of three or more previously published articles on both mesh-tissue adhesion scores and postoperative adhesions were marked as experts. They were queried on seven items using a modified Delphi method. The items concerned the utility of adhesion scoring models, the appropriateness of macroscopic and microscopic variables, the range and use of composite scores or subscores, adhesion-related complications and follow-up length. This study comprised two questionnaire-based rounds and one consensus meeting.

Results

The first round was completed by 23 experts (82%), the second round by 18 experts (64%). Of those 18 experts, ten were able to participate in the final consensus meeting and all approved the final proposal. From a total of 158 items, consensus was reached on 90 items. The amount of mesh surface covered with adhesions, tenacity and thickness of adhesions and organ involvement was concluded to be a minimal set of variables to be communicated separately in each future study on mesh adhesions.

Conclusion

The MEsh Tissue Adhesion scoring system is the first consensus-based scoring system with a wide backing of renowned experts and can be used to assess mesh-related adhesions. By including this minimal set of variables in future research interstudy comparability and objectivity can be increased and eventually linked to clinically relevant outcomes.

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Funding

No grants or other financial support were received for this study.

Author information

Authors and Affiliations

  1. Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    L. C. L. van den Hil, E. H. H. Mommers, J. W. A. M. Bosmans, M. H. F. Schreinemacher & N. D. Bouvy

  2. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands

    L. C. L. van den Hil, E. H. H. Mommers, J. W. A. M. Bosmans, M. H. F. Schreinemacher & N. D. Bouvy

  3. Unit of Innovation and Minimally Invasive Surgery, University Hospital Virgen Del Rocío, Seville, Spain

    S. Morales-Conde

  4. Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), University of Alcalá, Alcalá de Henares, Madrid, Spain

    V. Gómez-Gil

  5. Our Lady of the Lake Physician Group, Minimally Invasive Surgery Institute, Baton Rouge, LA, USA

    K. LeBlanc

  6. Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium

    A. Vanlander, E. Reynvoet & F. Berrevoet

  7. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Vienna, Austria

    S. Gruber-Blum & A. H. Petter-Puchner

  8. Department of General Surgery, Bilim University, Istanbul, Turkey

    E. Altinli

  9. Covalent Bio, LLC, St. Louis, MO, USA

    C. R. Deeken

  10. Department of General Surgery, Wilhelminenspital Der Stadt Wien, Vienna, Austria

    R. H. Fortelny & A. H. Petter-Puchner

  11. Department of General Surgery, Zuyderland Medical Center, Heerlen, The Netherlands

    J. W. Greve

  12. Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ghent, Ghent, Belgium

    K. Chiers

  13. Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

    R. Kaufmann & J. F. Lange

  14. Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany

    U. Klinge

  15. Department of Abdominal Surgery, University Hospitals, KU Leuven, Leuven, Belgium

    M. Miserez

Authors
  1. L. C. L. van den Hil
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  2. E. H. H. Mommers
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  3. J. W. A. M. Bosmans
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  4. S. Morales-Conde
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  5. V. Gómez-Gil
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  6. K. LeBlanc
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  7. A. Vanlander
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  8. E. Reynvoet
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  9. F. Berrevoet
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  10. S. Gruber-Blum
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  11. E. Altinli
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  12. C. R. Deeken
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  13. R. H. Fortelny
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  14. J. W. Greve
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  15. K. Chiers
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  16. R. Kaufmann
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  17. J. F. Lange
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  18. U. Klinge
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  19. M. Miserez
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  20. A. H. Petter-Puchner
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  21. M. H. F. Schreinemacher
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  22. N. D. Bouvy
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Corresponding author

Correspondence to L. C. L. van den Hil.

Ethics declarations

Conflict of interest

SM declares conflicts of interest, since he has received speaker honorarium from Bard, Medtronic, Stryker, Storz and Ethicon. Furthermore, he is a member of the Advisory Board from Bard. However, this fact did not influence the content of this paper. CD declares conflicts of interest, since she received consulting fees from Colorade Therapeutics, TELA Bio, Ethicon, Musculoskeletal Transplant Foundation, Biom'Up, CR Bard and Surgical Innovation Associates. In addition, she has a patent on Bionanocomposite for tissue regeneration and soft tissue repair issued. However, these facts did not influence the content of this paper. LH, EM, JB, VG, KL, AV, ER, FB, SG, EA, RF, JG, KC, RK, JL, UK, MM, AP, MS, NB declare no conflict of interest that influences the content of this paper.

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This article does not contain any studies with human participants performed by any of the authors.

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van den Hil, L.C.L., Mommers, E.H.H., Bosmans, J.W.A.M. et al. META Score: An International Consensus Scoring System on Mesh-Tissue Adhesions. World J Surg 44, 2935–2943 (2020). https://doi.org/10.1007/s00268-020-05568-1

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  • DOI: https://doi.org/10.1007/s00268-020-05568-1

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