Guidelines for Treatment of Umbilical and Epigastric Hernias From the European and Americas Hernia Societies-A Web-Based Survey on Surgeons' Opinion

N A Henriksen; T Nazari; M P Simons; W Hope; A Montgomery

doi:10.3389/jaws.2022.10260

Guidelines for Treatment of Umbilical and Epigastric Hernias From the European and Americas Hernia Societies-A Web-Based Survey on Surgeons' Opinion

J Abdom Wall Surg. 2022 Mar 21:1:10260. doi: 10.3389/jaws.2022.10260. eCollection 2022.

Authors

N A Henriksen^{1

2}, T Nazari³, M P Simons⁴, W Hope⁵, A Montgomery⁶

Affiliations

¹ Department of Gastrointestinal and Liver Diseases, Herlev Hospital, Herlev, Denmark.
² Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.
³ Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands.
⁴ Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands.
⁵ New Hanover Regional Medical Center, Wilmington, DE, United States.
⁶ Faculty of Medicine, Department of Surgery, Skane University Hospital, Malmö, Sweden.

Abstract

Background and aims: The European and Americas Hernia Society's (EHS and AHS) Guidelines on the treatment of primary midline ventral hernias were launched to guide surgeons. As a part of a dissemination plan of the guideline, this study aimed to evaluate the level of consensus between recommendations and the current surgical practices of EHS and AHS members before implementation. Material and methods: A questionnaire was constructed including questions on the current practice of the members and nine selected key recommendations from the guidelines. An on-stage consensus voting was performed at the EHS Congress in Hamburg 2019 followed by a SurveyMonkey sent to all EHS and AHS members. Consensus with a recommendation was defined as an agreement of ≥70%. Results: A total of 178 votes were collected in Hamburg. A further 499/1,754 (28.4%) of EHS and 150/1,100 (13.6%) of AHS members participated in the SurveyMonkey. A consensus was reached for 7/9 (78%) of the recommendations. The two recommendations that did not reach consensus were on indication and the technique used for laparoscopic repair. In current practice, more AHS participants used a preformed patch; 50.7% (76/150) compared with EHS participants 32.1% (160/499), p < 0.001. Conclusion: A consensus was achieved for most recommendations given by the new guideline for the treatment of umbilical and epigastric hernias. Recommendations that did not reach consensus were on indication and technique for laparoscopic repair, which may reflect the lack of evidence on these topics.

Keywords: SurveyMonkey; epigastric; level of consensus; survey; umbilical; voting.