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Delphi consensus statement for understanding and managing the subcostal hernia: subcostal hernias collaborative

S J Baig1, G V Kulkarni2, P Priya3

  • 1Department of Minimal Access Surgery, Belle Vue Clinic, Digestive Surgery Clinic, Bellevue Hospital Kolkata, Kolkata, 700017, India. docsarfarazbaig@gmail.com.

Hernia : the Journal of Hernias and Abdominal Wall Surgery
|February 17, 2024
PubMed
Summary

This Delphi consensus study provides guidelines for managing subcostal hernias (SCH), common after abdominal surgeries. Experts agreed on mesh use, retromuscular placement, and specific techniques for incision and defect closure in SCH repair.

Keywords:
Complex herniaDelphi consensusL1 herniaSubcostal herniaVentral hernia

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Area of Science:

  • Abdominal Surgery
  • Hernia Repair
  • Surgical Consensus

Background:

  • Subcostal hernias (SCH) are common, particularly after hepatopancreaticobiliary surgeries.
  • Existing literature on SCH is limited, lacking consensus and guidelines for management.
  • This necessitates the development of standardized approaches for SCH treatment.

Purpose of the Study:

  • To establish a consensus on the definition, characteristics, and surgical management of subcostal hernias (SCH).
  • To provide evidence-based recommendations for decision-making in SCH repair.
  • To address the lack of established guidelines in the surgical community.

Main Methods:

  • A modified Delphi technique was employed, involving a four-phase process.
  • A diverse panel of 22 international surgical experts participated.
  • Consensus was defined as over 70% agreement on specific queries.

Main Results:

  • Consensus was reached on using mesh in elective cases, favoring retromuscular placement over onlay.
  • Recommendations include using macroporous, medium-weight polypropylene mesh.
  • Agreed-upon techniques include subcostal incision (if no prior midline), Transversus Abdominis Release (TAR) over anterior component separation, defect closure with mesh-assisted suturing, transverse suturing for circular defects, and using a peritoneal flap when needed.

Conclusions:

  • This Delphi consensus provides a framework for subcostal hernia (SCH) management.
  • It offers insights into optimal incision, dissection plane, mesh selection, and fixation.
  • These findings aim to guide surgeons in the effective repair of subcostal hernias.