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Review
. 2024 Oct;28(5):1511-1523.
doi: 10.1007/s10029-024-03062-4. Epub 2024 May 9.

Ventral hernia repair in India: a Delphi consensus

P Chowbey  1 , R Wadhawan  2 , D Subramanian  3 , D Bhandarkar  4 , J Gandhi  5 , K L Kumari  6 , M Baijal  1 , M Khetan  7 , M S Kathalagiri  8 , P Khandelwal  9 , P Lal  10 , P Dasgupta  11 , P Balachandran  12 , S Dave  13 , S J Baig  14 , V Soni  1
Affiliations
Review

Ventral hernia repair in India: a Delphi consensus

P Chowbey et al. Hernia. 2024 Oct.

Abstract

Purpose: While research on inguinal hernias is well-documented, ventral/incisional hernias still require investigation. In India, opinions on laparoscopic ventral hernia repair (LVHR) techniques are contested. The current consensus aims to standardize LVHR practice and identify gaps and unfulfilled demands that compromise patient safety and therapeutic outcomes.

Methods: Using the modified Delphi technique, panel of 14 experts (general surgeons) came to a consensus. Two rounds of consensus were conducted online. An advisory board meeting was held for the third round, wherein survey results were discussed and the final statements were decided with supporting clinical evidence.

Results: Experts recommended intraperitoneal onlay mesh (IPOM) plus/trans-abdominal retromuscular/extended totally extraperitoneal/mini- or less-open sublay operation/transabdominal preperitoneal/trans-abdominal partial extra-peritoneal/subcutaneous onlay laparoscopic approach/laparoscopic intracorporeal rectus aponeuroplasty as valid minimal access surgery (MAS) options for ventral hernia (VH). Intraperitoneal repair technique is the preferred MAS procedure for primary umbilical hernia < 4 cm without diastasis; incisional hernia in the presence of a vertical single midline incision; symptomatic hernia, BMI > 40 kg/m2, and defect up to 4 cm; and for MAS VH surgery with grade 3/4 American Society of Anaesthesiologists. IPOM plus is the preferred MAS procedure for midline incisional hernia of width < 4 cm in patients with a previous laparotomy. Extraperitoneal repair technique is the preferred MAS procedure for L3 hernia < 4 cm; midline hernias < 4 cm with diastasis; and M5 hernia.

Conclusion: The consensus statements will help standardize LVHR practices, improve decision-making, and provide guidance on MAS in VHR in the Indian scenario.

Keywords: Intraperitoneal onlay mesh; Laparoscopic; Minimal access surgery; Ventral hernia.

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Conflict of interest statement

Authors Pradeep Chowbey, Randeep Wadhawan, Deepak Subramanian, Deepraj Bhandarkar, Jignesh Gandhi, Kona Lakshmi Kumari, Manish Baijal, Mukund Khetan, Muralidhar S. Kathalagiri, Pankaj Khandelwal, Pawanindra Lal, Pinak Dasgupta, Premkumar Balachandran, Sandeep Dave, Sarfaraz J Baig and Vandana Soni declare that they have no conflict of interest.

References

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