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Criteria for definition of a complex abdominal wall hernia

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Abstract

Purpose

A clear definition of “complex (abdominal wall) hernia” is missing, though the term is often used. Practically all “complex hernia” literature is retrospective and lacks proper description of the population. There is need for clarification and classification to improve patient care and allow comparison of different surgical approaches. The aim of this study was to reach consensus on criteria used to define a patient with “complex” hernia.

Methods

Three consensus meetings were convened by surgeons with expertise in complex abdominal wall hernias, aimed at laying down criteria that can be used to define “complex hernia” patients, and to divide patients in severity classes. To aid discussion, literature review was performed to identify hernia classification systems, and to find evidence for patient and hernia variables that influence treatment and/or prognosis.

Results

Consensus was reached on 22 patient and hernia variables for “complex” hernia criteria inclusion which were grouped under four categories: “Size and location”, “Contamination/soft tissue condition”, “Patient history/risk factors”, and “Clinical scenario”. These variables were further divided in three patient severity classes (‘Minor’, ‘Moderate’, and ‘Major’) to provide guidance for peri-operative planning and measures, the risk of a complicated post-operative course, and the extent of financial costs associated with treatment of these hernia patients.

Conclusion

Common criteria that can be used in defining and describing “complex” (abdominal wall) hernia patients have been identified and divided under four categories and three severity classes. Next step would be to create and validate treatment algorithms to guide the choice of surgical technique including mesh type for the various complex hernias.

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References

  1. Sharma RK, Singh G, Naidu PM (1998) Abdominal wall defects: anatomic classification and a scheme for management. Ann Plast Surg 41(2):180–184

    Article  CAS  PubMed  Google Scholar 

  2. Chevrel J, Rath R (2000) Classification of incisional hernias of the abdominal wall. Hernia 4:7–11

    Article  Google Scholar 

  3. Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr (2003) Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg 111(2):909–923

    Article  PubMed  Google Scholar 

  4. Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RK (2001) Classification and surgical treatment of incisional hernia. Results of an experts’ meeting. Langenbecks Arch Surg 386(1):65–73

    Article  CAS  PubMed  Google Scholar 

  5. Ammaturo C, Bassi G (2005) The ratio between anterior abdominal wall surface/wall defect surface: a new parameter to classify abdominal incisional hernias. Hernia 9(4):316–321

    Article  CAS  PubMed  Google Scholar 

  6. Chowbey PK, Khullar R, Mehrotra M, Sharma A, Soni V, Baijal M (2006) Sir Ganga Ram Hospital classification of groin and ventral abdominal wall hernias. J Minim Access Surg 2(3):106–109

    Article  PubMed Central  PubMed  Google Scholar 

  7. Dietz UA, Hamelmann W, Winkler MS, Debus ES, Malafaia O, Czeczko NG, Thiede A, Kuhfuss I (2007) An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique. J Plast Reconstr Aesthet Surg 60(4):383–388

    Article  CAS  PubMed  Google Scholar 

  8. Conze J, Junge K, Klinge U, Schumpelick V (2006) Evidence-based laparoscopic surgery—incisional hernia. Viszeralchirurgie 41:246–253

    Article  Google Scholar 

  9. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558

    Article  PubMed  Google Scholar 

  11. Hadeed JG, Walsh MD, Pappas TN, Pestana IA, Tyler DS, Levinson H, Mantyh C, Jacobs DO, Lagoo-Deenadalayan SA, Erdmann D (2011) Complex abdominal wall hernias: a new classification system and approach to management based on review of 133 consecutive patients. Ann Plast Surg 66(5):497–503

    Article  CAS  PubMed  Google Scholar 

  12. Blatnik JA, Harth KC, Aeder MI, Rosen MJ (2011) Thirty-day readmission after ventral hernia repair: predictable or preventable? Surg Endosc 25(5):1446–1451

    Article  PubMed  Google Scholar 

  13. Hesselink VJ, Luijendijk RW, de Wilt JH, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176(3):228–234

    CAS  PubMed  Google Scholar 

  14. Hansson BM, Slater NJ, van der Velden AS, Groenewoud HM, Buyne OR, de Hingh IH, Bleichrodt RP (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255(4):685–695

    Article  PubMed  Google Scholar 

  15. Sabbagh C, Dumont F, Robert B, Badaoui R, Verhaeghe P, Regimbeau JM (2011) Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study. Hernia 15(5):559–565

    Article  CAS  PubMed  Google Scholar 

  16. Berard F, Gandon J (1964) Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg 160(Suppl 2):1–192

    CAS  PubMed  Google Scholar 

  17. Slater NJ, Bleichrodt RP, van Goor H (2012) Wound dehiscence and incisional hernia. Surgery (Oxford) 30(6):282–289

    Article  Google Scholar 

  18. Birolini C, Utiyama EM, Rodrigues AJ Jr, Birolini D (2000) Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? J Am Coll Surg 191(4):366–372

    Article  CAS  PubMed  Google Scholar 

  19. Geisler DJ, Reilly JC, Vaughan SG, Glennon EJ, Kondylis PD (2003) Safety and outcome of use of nonabsorbable mesh for repair of fascial defects in the presence of open bowel. Dis Colon Rectum 46(8):1118–1123

    Article  PubMed  Google Scholar 

  20. Kelly ME, Behrman SW (2002) The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds. Am Surg 68(6):524–528

    PubMed  Google Scholar 

  21. Machairas A, Liakakos T, Patapis P, Petropoulos C, Tsapralis D, Misiakos EP (2008) Prosthetic repair of incisional hernia combined with elective bowel operation. Surgeon 6(5):274–277

    Article  CAS  PubMed  Google Scholar 

  22. McNeeley SG Jr, Hendrix SL, Bennett SM, Singh A, Ransom SB, Kmak DC, Morley GW (1998) Synthetic graft placement in the treatment of fascial dehiscence with necrosis and infection. Am J Obstet Gynecol 179(6):1430–1434

    Article  PubMed  Google Scholar 

  23. Vix J, Meyer C, Rohr S, Bourtoul C (1997) The treatment of incisional and abdominal hernia with a prosthesis in potentially infected tissues—aseries of 47 cases. Hernia 1:157–161

    Article  Google Scholar 

  24. Slater NJ, Van der Kolk BM, Hendriks T, Van Goor H, Bleichrodt RP (2012) Biologic grafts for ventral hernia repair: a systematic review. Am J Surg 205(2):220–230

    Article  PubMed  Google Scholar 

  25. de Vries Reilingh TS, Bodegom ME, van Goor H, Hartman EH, van der Wilt GJ, Bleichrodt RP (2007) Autologous tissue repair of large abdominal wall defects. Br J Surg 94(7):791–803

    Article  PubMed  Google Scholar 

  26. Si Z, Bhardwaj R, Rosch R, Mertens PR, Klosterhalfen B, Klinge U (2002) Impaired balance of type I and type III procollagen mRNA in cultured fibroblasts of patients with incisional hernia. Surgery 131(3):324–331

    Article  PubMed  Google Scholar 

  27. Girotto JA, Malaisrie SC, Bulkely G, Manson PN (2000) Recurrent ventral herniation in Ehlers-Danlos syndrome. Plast Reconstr Surg 106(7):1520–1526

    Article  CAS  PubMed  Google Scholar 

  28. Liem MS, van der Graaf Y, Beemer FA, van Vroonhoven TJ (1997) Increased risk for inguinal hernia in patients with Ehlers-Danlos syndrome. Surgery 122(1):114–115

    Article  CAS  PubMed  Google Scholar 

  29. Lin IC, Ko SF, Shieh CS, Huang CF, Chien SJ, Liang CD (2006) Recurrent congenital diaphragmatic hernia in Ehlers-Danlos syndrome. Cardiovasc Intervent Radiol 29(5):920–923

    Article  PubMed  Google Scholar 

  30. Thomas GP, Purkayastha S, Athanasiou T, Darzi A (2008) General surgical manifestations of Marfan’s syndrome. Br J Hosp Med (Lond) 69(5):270–274

    CAS  Google Scholar 

  31. Morris-Stiff G, Coles G, Moore R, Jurewicz A, Lord R (1997) Abdominal wall hernia in autosomal dominant polycystic kidney disease. Br J Surg 84(5):615–617

    Article  CAS  PubMed  Google Scholar 

  32. Hackley L, Merritt L (2008) Osteogenesis imperfecta in the neonate. Adv Neonatal Care 8(1):21–30

    Article  PubMed  Google Scholar 

  33. Uden A, Lindhagen T (1988) Inguinal hernia in patients with congenital dislocation of the hip. A sign of general connective tissue disorder. Acta Orthop Scand 59(6):667–668

    Article  CAS  PubMed  Google Scholar 

  34. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135

    Article  PubMed  Google Scholar 

  35. Sorensen LT, Hemmingsen U, Kallehave F, Wille-Jorgensen P, Kjaergaard J, Moller LN, Jorgensen T (2005) Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg 241(4):654–658

    Article  PubMed  Google Scholar 

  36. van’t RM, De Vos Van Steenwijk PJ, Bonjer HJ, Steyerberg EW, Jeekel J (2004) Incisional hernia after repair of wound dehiscence: incidence and risk factors. Am Surg 70(4):281–286

    PubMed  Google Scholar 

  37. van Ramshorst GH, Nieuwenhuizen J, Hop WC, Arends P, Boom J, Jeekel J, Lange JF (2010) Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 34(1):20–27

    Article  PubMed Central  PubMed  Google Scholar 

  38. ten Broek RP, Schreinemacher MH, Jilesen AP, Bouvy N, Bleichrodt RP, van Goor H (2012) Enterotomy risk in abdominal wall repair: a prospective study. Ann Surg 256(2):280–287

    Article  PubMed  Google Scholar 

  39. Connolly PT, Teubner A, Lees NP, Anderson ID, Scott NA, Carlson GL (2008) Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg 247(3):440–444

    Article  PubMed  Google Scholar 

  40. Krpata DM, Stein SL, Eston M, Ermlich B, Blatnik JA, Novitsky YW, Rosen MJ (2013) Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg 205(3):354–358

    Article  PubMed  Google Scholar 

  41. Slater NJ, Hansson BM, Buyne OR, Hendriks T, Bleichrodt RP (2011) Repair of parastomal hernias with biologic grafts: a systematic review. J Gastrointest Surg 15(7):1252–1258

    Article  PubMed Central  PubMed  Google Scholar 

  42. Berrevoet F, Vanlander A, Sainz-Barriga M, Rogiers X, Troisi R (2012) Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia 17(1):67–73

    Article  PubMed  Google Scholar 

  43. Carbonell AM, Cobb WS, Chen SM (2008) Posterior components separation during retromuscular hernia repair. Hernia 12(4):359–362

    Article  CAS  PubMed  Google Scholar 

  44. Conze J, Krones CJ, Schumpelick V, Klinge U (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbeck Arch Surg 392(4):453–457

    Article  Google Scholar 

  45. Franklin M, Russek K (2011) Use of porcine small intestine submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up assessment. Surg Endosc 25(5):1693–1694

    Article  PubMed  Google Scholar 

  46. Kercher KW, Sing RF, Matthews BD, Heniford BT (2002) Successful salvage of infected PTFE mesh after ventral hernia repair. Ostomy Wound Manage 48(10):40–42 44–45

    PubMed  Google Scholar 

  47. Lammers BJ, Goretzki PE, Otto T (2005) New aspects in hernia surgery. Urologe A 44(7):774–779

    Article  CAS  PubMed  Google Scholar 

  48. Montgomery A, Petersson U, Austrums E (2013) The arcuate line hernia: operative treatment and a review of the literature. Hernia 17(3):391–396

    Article  CAS  PubMed  Google Scholar 

  49. Friedrich M, Muller-Riemenschneider F, Roll S, Kulp W, Vauth C, Greiner W, Willich S, von der Schulenburg JM (2008) Health Technology Assessment of laparoscopic compared to conventional surgery with and without mesh for incisional hernia repair regarding safety, efficacy and cost-effectiveness. GMS Health Technol Assess 4: Doc01

  50. Towfigh S, Cheadle WG, Lowry SF, Malangoni MA, Wilson SE (2008) Significant reduction in incidence of wound contamination by skin flora through use of microbial sealant. Arch Surg 143(9):885–891

    Article  PubMed  Google Scholar 

  51. van Geffen HJ, Simmermacher RK, van Vroonhoven TJ, van der Werken C (2005) Surgical treatment of large contaminated abdominal wall defects. J Am Coll Surg 201(2):206–212

    Article  PubMed  Google Scholar 

  52. Kanters AE, Krpata DM, Blatnik JA, Novitsky YM, Rosen MJ (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215(6):787–793

    Article  PubMed  Google Scholar 

  53. Vix J, Meyer C, Rohr S, Bourtoul C (1997) The treatment of incisional and abdominal hernia with a prosthesis in potentially infected tissues—a series of 47 cases. Hernia 157–161

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Conflict of interest

All authors declare conflict of interest directly related to the submitted work (consultancy fee and travel support).

Author information

Authors and Affiliations

  1. Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

    N. J. Slater & H. van Goor

  2. Skåne University Hospital, Malmö, Sweden

    A. Montgomery

  3. University Hospital Ghent, Ghent, Belgium

    F. Berrevoet

  4. Hernia Center of the Greenville Health System, Greenville, SC, USA

    A. M. Carbonell

  5. Kings College NHS Foundation Trust, London, UK

    A. Chang

  6. Texas Endosurgery Institute, San Antonio, USA

    M. Franklin

  7. Carolinas Medical Center, Charlotte, NC, USA

    K. W. Kercher

  8. Stradhsche Klinika Neuss, Neuss, Germany

    B. J. Lammers

  9. Florida Physicians Medical Group, Orlando, FL, USA

    E. Parra-Davilla

  10. University of Sao Paulo, Sao Paulo, Brazil

    S. Roll

  11. Cedars-Sinai Medical Centre, Los Angeles, CA, USA

    S. Towfigh

  12. Jeroen Bosch Hospital, Den Bosch, The Netherlands

    E. van Geffen

  13. Hernia Centre Munich, Munich, Germany

    J. Conze

Authors
  1. N. J. Slater
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  2. A. Montgomery
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  3. F. Berrevoet
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  4. A. M. Carbonell
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  5. A. Chang
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  8. B. J. Lammers
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  10. S. Roll
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  13. J. Conze
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  14. H. van Goor
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Correspondence to N. J. Slater.

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Slater, N.J., Montgomery, A., Berrevoet, F. et al. Criteria for definition of a complex abdominal wall hernia. Hernia 18, 7–17 (2014). https://doi.org/10.1007/s10029-013-1168-6

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  • DOI: https://doi.org/10.1007/s10029-013-1168-6

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