Abstract
Background: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. Methods: The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. Results: Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. Conclusion: This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
| Original language | English |
|---|---|
| Pages (from-to) | 171-190 |
| Number of pages | 20 |
| Journal | British Journal of Surgery |
| Volume | 107 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Feb 1 2020 |
Bibliographical note
Funding Information:The project was approved by the EHS and AHS boards in February 2017. Two coordinators were appointed to manage the project. The guideline was intended for surgeons, general practitioners and patients. A list of the members of the group and their responsibilities is available in the acknowledgements. Conflicts of interest (COI) for each member were recorded transparently. The meetings were funded by the EHS and AHS. There was no involvement from industry.
Funding Information:
The two guideline coordinators were N.A.H. and M.P.S. The group members covered Northern (N.A.H, R.K., A.M., R.L., M.P.S., F.B.), Southern (Y.R., M.U.-G.) and Eastern (B.E.) Europe, together with Canada (D.K.) and North America (J.F., W.H.), and consisted of 11 general surgeons and one plastic surgeon (J.F.), all specialized in abdominal wall repairs. Initially, there was also a 13th member from South America, but this member withdrew participation. Care was taken to include surgeons performing open (J.F.) and/or laparoscopic operations (all) and from academic (A.M., F.B., Y.R., J.F., N.A.H., B.E.) and district (M.P.S.) hospitals, and one from a private clinic (R.L.). Some surgeons with guideline expertise (N.A.H., M.P.S., F.B., A.M., W.H., B.E.), a young PhD physician (R.K.), a surgeon with expertise in anatomy (Y.R.), experienced researchers with more than 30 publications (N.A.H., J.F., M.P.S., F.B.), and very experienced researchers with over 50 publications (A.M., W.H.) were included. N.A.H. and R.K carried out the systematic review. N.A.H. has indirect COI as a member of the Danish Hernia Database steering committee and having attended an industry-sponsored meeting. A.M. is a member of the EHS board, and has received speaker's fees from Intuitive and Bard (direct COI). R.K. is the author of the HUMP trial and has attended sponsored meetings (indirect COI). F.B. has received speaker's fees from Medtronic and Acelity (direct COI). J.F. has received speaker's fees from Bard, Gore and Allergan, research funding from the National Institutes of Health, National Science Foundation and Integra, and is a member of the advisory board for Mesh Suture (direct COI). W.H. has received speaker's fees from Bard, Gore and Intuitive, and is a member of advisory boards for Mesh Suture and Deep Blue Medical (direct COI). D.K. has received speaker's fees from Gore, Bard and Cook (direct COI). R.L. has direct COI in terms of speaker's fees from Medtronic and training courses from Bard (fee), and indirect COI as a member of the EHS board, participation in sponsored meetings, and being part of Hernientage and HerniaMed. Y.R. has received research funding from Medtronic, Bard and Hartmann (direct COI). M.U. has received speaker's fees from Gore, Medtronic and Dynamesh. M.P.S. is a member of the EHS board and has participated in sponsored meetings (indirect COI). Disclosure: The authors declare no other conflict of interest.
Publisher Copyright:
© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd
ASJC Scopus Subject Areas
- Surgery
PubMed: MeSH publication types
- Journal Article
- Review