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Establishing Peer Consensus About the Use of Long-Term Biosynthetic Absorbable Mesh for Hernia (Grades 2–3) as the Standard of Care

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Abstract

Background

Standard synthetic and biologic meshes, often used in hernia repair, have commonly been used and each have their strengths but associated drawbacks. Long-term biosynthetic absorbable (LTBA) mesh has been developed to combine the strengths of synthetic and biologic meshes without the associated weaknesses. As a newer type of mesh, the supporting evidence base is still growing, and their optimum use has yet to be defined. This consensus was initiated to provide insight into those situations where a LTBA might be considered the Standard of Care in ventral hernia repair grades 2–3 (original classification, 2010) of the Ventral Hernia Working Group.

Methods

A steering group of expert surgeons identified 35 statements, based around the evidence supporting LTBA, surgical technique, patients type most suitable for LTBA, risk–benefit of LTBA, patient and surgeon considerations, LTBA value. Surgeons involved in hernia repair received an online survey to assess consensus with these statements. Consensus was defined as high if ≥ 70% and very high if ≥ 90% of respondents agreed. Statements that had not achieved consensus agreement were revised and these were then issued for a subsequent round. Finally, 34 statements were included.

Results

Two hundred fifty-five surgeons were involved. Fourteen statements (41%) achieved very high consensus, 24 achieved consensuses (≥ 70–< 90%), whilst one (3%) just failed to achieve consensus with an agreement score of 69%.

Conclusions

Expert consensus opinion about the use of LTBA for hernia (Grades 2–3) as the Standard of Care was achieved. Based on the consensus scores, the steering group derived eleven keys.

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Funding

This project was funded by BD Medical Ltd by supporting the costs of methodological process, which was performed by Triducive Partners Limited. Ian Walker and Tim Warren worked with Triducive Partners Limited and acted as independent facilitators during the expert group discussions to identify key topics and to capture the expert consensus statements. The survey distribution and analysis of results were performed by the experts and remained anonymous and independent.

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Authors and Affiliations

  1. Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Seville, Spain

    Salvador Morales-Conde

  2. Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazon, Seville, Spain

    Salvador Morales-Conde

  3. Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium

    Frederick Berrevoet

  4. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen NV, Denmark

    Lars Nannestad Jorgensen

  5. Colorectal Surgery Unit, Department of Surgery, Campus Bio-Medico University of Rome, Rome, Italy

    Domenico Marchi

  6. Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France

    Pablo Ortega-Deballon

  7. Consultant Surgeon, HCA Healthcare UK, London Digestive Centre, London, UK

    Alistair Windsor

Authors
  1. Salvador Morales-Conde
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  2. Frederick Berrevoet
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Corresponding author

Correspondence to Salvador Morales-Conde.

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Conflict of interest

Morales-Conde Salvador, Berrevoet Frederick, Lars Nannestad Jorgensen, Marchi Domenico, Ortega-Deballon Pablo, and Windsor Alistair have no conflicts of interest or financial ties to disclose.

Ethical standard

The present study was approved by our institutional review board.

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Informed consent was obtained from all individual participants included in the study.

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Morales-Conde, S., Berrevoet, F., Jorgensen, L.N. et al. Establishing Peer Consensus About the Use of Long-Term Biosynthetic Absorbable Mesh for Hernia (Grades 2–3) as the Standard of Care. World J Surg 46, 2996–3004 (2022). https://doi.org/10.1007/s00268-022-06743-2

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