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Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement

BACKGROUND: The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh r...

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Autores principales: Grove, T N, Kontovounisios, C, Montgomery, A, Heniford, B T, Windsor, A C J, Warren, O J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473840/
https://www.ncbi.nlm.nih.gov/pubmed/34568888
http://dx.doi.org/10.1093/bjsopen/zrab082
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author Grove, T N
Kontovounisios, C
Montgomery, A
Heniford, B T
Windsor, A C J
Warren, O J
author_facet Grove, T N
Kontovounisios, C
Montgomery, A
Heniford, B T
Windsor, A C J
Warren, O J
author_sort Grove, T N
collection PubMed
description BACKGROUND: The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. METHODS: The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. RESULTS: Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. CONCLUSION: Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.
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spelling pubmed-84738402021-09-27 Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement Grove, T N Kontovounisios, C Montgomery, A Heniford, B T Windsor, A C J Warren, O J BJS Open Original Article BACKGROUND: The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20–41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. METHODS: The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. RESULTS: Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. CONCLUSION: Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR. Oxford University Press 2021-09-27 /pmc/articles/PMC8473840/ /pubmed/34568888 http://dx.doi.org/10.1093/bjsopen/zrab082 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Grove, T N
Kontovounisios, C
Montgomery, A
Heniford, B T
Windsor, A C J
Warren, O J
Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement
title Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement
title_full Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement
title_fullStr Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement
title_full_unstemmed Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement
title_short Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement
title_sort perioperative optimization in complex abdominal wall hernias: delphi consensus statement
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473840/
https://www.ncbi.nlm.nih.gov/pubmed/34568888
http://dx.doi.org/10.1093/bjsopen/zrab082
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