What defines an incisional hernia as ‘complex’: results from a Delphi consensus endorsed by the European Hernia Society (EHS)
2023-10-28
SCID: 54.1/zavrj6qb
Abstract (AI)
A ‘complex’ hernia is often referred to in the published literature, yet has not been clearly defined to date. ‘Large’ and ‘giant’ may also be used to describe a complex incisional hernia indirectly1–3. Meanwhile, a ‘complex hernia’ in reference to the technical surgical challenge of abdominal wall repair is different from a ‘complex patient’, the latter relating more to a patient’s mental or physical health. Several risk scores have been developed and described in the literature2,4–6. Although hernia dimensions and defect characteristics alongside patient co-morbidities have demonstrated some correlation with poor surgical outcomes1,3, postoperative complications alone should not define complexity6,7. Slater et al.8 subsequently published criteria to define a complex abdominal wall hernia, comprising four categories: size and location, contamination/soft tissue condition, patient history/risk factors, and clinical scenario; three severity classes were defined, namely minor, moderate, and major. Although often referenced in publications, this definition has not been found to be an efficient working definition of a complex incisional hernia4,9. Furthermore, with increasing preoperative adjuncts and operative strategies available to manage incisional hernia6,10, and increased surgical specialization in the field2,10, a revised consensus definition is required.
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2023-10-28
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