Criteria for definition of a complex abdominal wall hernia

Area of Science:

• Hernia Surgery
• Surgical Classification Systems
• Abdominal Wall Reconstruction

Background:

• The term "complex abdominal wall hernia" lacks a clear, standardized definition, hindering consistent patient description and research.
• Existing literature on complex hernias is often retrospective, lacking detailed population characteristics and hindering comparative analysis of surgical outcomes.
• There is a critical need for a consensus-based classification system to improve patient care and facilitate objective comparisons of diverse surgical strategies.

Purpose of the Study:

• To achieve consensus on criteria defining patients with complex abdominal wall hernias.
• To develop a classification system for complex hernia patient severity.
• To improve patient care and enable comparison of surgical strategies.

Main Methods:

• Convened three consensus meetings with expert surgeons specializing in complex abdominal wall hernias.
• Conducted a literature review to identify existing hernia classification systems and relevant variables.
• Focused on establishing criteria for defining complex hernia patients and their severity classes.

Main Results:

• Achieved consensus on 22 variables for complex hernia criteria, categorized into "Size and location," "Contamination/soft tissue condition," "Patient history/risk factors," and "Clinical scenario."
• Developed three patient severity classes: 'Minor,' 'Moderate,' and 'Major.'
• These classifications aid in peri-operative planning, risk assessment, and cost management for complex hernia treatment.

Conclusions:

• Identified common criteria and four categories for defining complex abdominal wall hernia patients.
• Established three severity classes to guide clinical decision-making.
• The next step involves developing and validating treatment algorithms for various complex hernias.