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

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.