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Ventral Hernia Management: Expert Consensus Guided by Systematic Review.
Mike K Liang1, Julie L Holihan, Kamal Itani
1*University of Texas Health Science Center at Houston, Houston, TX †Veterans Affairs Boston Healthcare System, Boston University and Harvard Medical School, Boston, MA ‡Baylor College of Medicine, Texas Medical Center, Houston, TX §Center for Minimally Invasive and Robotic Surgery, Peoria, AZ ¶University of Iowa, Iowa City, IA ||Medical College of Wisconsin, Milwaukee, WI **University of Wisconsin, Madison, WI ††Oregon Health and Science University, Portland, OR ‡‡West Virginia University, Morgantown, WV §§University of Kentucky, Lexington, KY ¶¶Indiana University Health, Indianapolis, IN ||||Beverly Hills Hernia Center, Beverly Hills, CA ***University of Nevada School of Medicine, Las Vegas, NV †††George Washington University, Washington, DC.
Expert consensus was reached on patient selection for ventral hernia repair (VHR), emphasizing risks in obese or smoking patients and benefits of mesh reinforcement for larger hernias. Gaps in evidence remain for complex cases.
Area of Science:
- Hernia Surgery
- Surgical Best Practices
- Evidence-Based Medicine
Background:
- Ventral hernia (VH) management varies widely, often lacking strong evidence.
- Heterogeneous management patterns necessitate consensus on best practices.
Framework:
- A systematic review identified highest-level evidence for VH management topics.
- Expert hernia surgeons convened to discuss and vote on management strategies.
- Consensus was defined as unanimous agreement among all participating experts.
Implementation:
- Consensus achieved on increased risks of VH repair (VHR) complications in obese patients, current smokers, and those with HbA1C ≥ 6.5%.
- Elective VHR discouraged for patients with BMI ≥ 50 kg/m², current smokers, or HbA1C ≥ 8.0%.
- Mesh reinforcement recommended for hernias ≥ 2 cm; nonoperative management deemed low-risk for short-term morbidity.
Implications:
- Consensus, supported by evidence, guides patient selection, nonoperative management, and mesh use in VHR.
- Significant gaps in evidence and practice variability exist for mesh type, component separation, and complex patient management.
- Further research is crucial to address knowledge gaps and refine VH treatment strategies.
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