Classification of primary and incisional abdominal wall hernias

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Abstract

Purpose

A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable.

Methods

Several members of the EHS board and some invitees gathered for 2 days to discuss the development of an EHS classification for primary and incisional abdominal wall hernias.

Results

To distinguish primary and incisional abdominal wall hernias, a separate classification based on localisation and size as the major risk factors was proposed. Further data are needed to define the optimal size variable for classification of incisional hernias in order to distinguish subgroups with differences in outcome.

Conclusions

A classification for primary abdominal wall hernias and a division into subgroups for incisional abdominal wall hernias, concerning the localisation of the hernia, was formulated.

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Most cited references 6

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The European hernia society groin hernia classification: simple and easy to remember.

M. Miserez, J. Alexandre, G. Campanelli … (2007)

After reviewing the available classifications for groin hernias, the European Hernia Society (EHS) proposes an easy and simple classification based on the Aachen classification. The EHS will promote the general and systematic use of this classification for intraoperative description of the type of hernia and to increase the comparison of results in the literature.

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Classification of incisional hernias of the abdominal wall

J Chevrel, A M Rath (2000)

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An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique.

N G Czeczko, M Thiede, W Hamelmann … (2006)

Incisional hernias occur in 5-10% of patients who have undergone laparotomy and are associated with a high morbidity and significant socioeconomic costs. Better understanding of the anatomy and improved methods for reinforcement of the abdominal wall with alloplastic meshes have reduced the recurrence rate to 1-10% depending on the type of hernia and the technique employed. A number of surgical repair techniques and mesh types are available. However, precise criteria for incorporating patient body type, risk factors for recurrence, hernia morphology, and the available biomaterials into planning of the surgical approach (open versus laparoscopic) have yet to be established. The elaboration of such criteria would require comparative evaluation of long-term results in a sufficiently large number of patients, e.g. in multicentre trials or meta-analyses of standardised data from different centres. Current classifications have the drawback that they fail to take account of prognostically relevant risk factors for recurrence and are not self-explanatory. The authors present a classification of incisional hernias that is self-explanatory and practicable in routine clinical practice. Based on the cornerstones of morphology (M), hernia size in cm (S), and risk factors for recurrence (RF), the scheme enables easy description and documentation of the hernia, and provides evidence for the indications and limitations of the main surgical repair techniques. Since randomised studies can scarcely be conducted on incisional hernias due to the numerous morphological variables, the classification presented here may offer an alternative means for comparative data analysis.

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Author and article information

Contributors

: +32-92607181 , +32-92607175 , filip.muysoms@azmmsj.be

Journal

Journal ID (nlm-ta): Hernia

Title: Hernia

Publisher: Springer-Verlag (Paris )

ISSN (Print): 1265-4906

ISSN (Electronic): 1248-9204

Publication date (Electronic): 3 June 2009

Publication date (Print): August 2009

Volume: 13

Issue: 4

Pages: 407-414

Affiliations

[1 ]Department of Surgery, AZ Maria Middelares, Kortrijksesteenweg 1026, 9000 Ghent, Belgium

[2 ]Department of Abdominal Surgery, Universitair Ziekenhuis Leuven, Herestraat 49, 3000 Leuven, Belgium

[3 ]Department of General and Hepatobiliary Surgery, University Hospital Ghent, 2K12 IC De Pintelaan 185, 9000 Ghent, Belgium

[4 ]Department of Surgical Sciences, Multimedica Hospital, University of Insubria-Varese, Castellanza, Italy

[5 ]Chef du service de chirurgie, Centre Hospitalo-universitaire Jean Verdier digestive, Université Paris XIII, Avenue du 14 Juillet, 93140 Bondy, France

[6 ]Department of Digestive and Endocrine Surgery, Centre Hospitalier Universitaire de Tivoli, Avenue Max Buset 34, 7100 La Louvière, Belgium

[7 ]Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany

[8 ]Department of Surgery, Erasmus Medical Center, ‘s Gravendijkwal 230, 3051 CE Rotterdam, The Netherlands

[9 ]Clinic of Abdominal Wall and Upper GI Surgery, Erasme Hospital, 808 Route de Lennik, 1070 Brussels, Belgium

[10 ]Department of Surgery, Clinique Notre-Dame, Avenue Delmee 2, 7500 Tournai, Belgium

[11 ]Department of General and Digestive Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain

[12 ]Hernienpraxis Mainz, Rheinstr. 4 Fort Malakoff, 55116 Mainz, Germany

[13 ]Department of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany

[14 ]Department of Surgery, Malmö University Hospital, 20502 Malmö, Sweden

[15 ]Department of Surgery, University Hospital, 3584 CX Utrecht, The Netherlands

[16 ]Department of Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands

[17 ]Department of General and Endocrine Surgery and Transplantation, Medical University of Gdańsk, 7 Debinki Street, 80-211 Gdańsk, Poland

[18 ]Department of Surgery, O.L.V. van Lourdes Ziekehuis, Vijfseweg 150, 8790 Waregem, Belgium

[19 ]Department of Surgery, Imelda ziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium

[20 ]Department of Abdominal Surgery, ASZ Campus Aalst, Merestraat 80, 9300 Aalst, Belgium

[21 ]Peninsula Medical School, Derriford Hospital, Level 7, Plymouth, PL6 8DH UK

Article

Publisher ID: 518

DOI: 10.1007/s10029-009-0518-x

PMC ID: 2719726

PubMed ID: 19495920

SO-VID: 04ad71a9-75b9-4712-ad77-e45edaf43149

History

Date received : 9 February 2009

Date accepted : 7 May 2009

Custom metadata

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: classification,ventral hernia,incisional hernia,abdominal wall hernia,umbilical hernia,epigastric hernia

Data availability:

ScienceOpen disciplines: Gastroenterology & Hepatology

Keywords: classification, ventral hernia, incisional hernia, abdominal wall hernia, umbilical hernia, epigastric hernia

Classification of primary and incisional abdominal wall hernias

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Abstract

Purpose

Methods

Results

Conclusions

Related collections

Karger: Gastroenterology

Most cited references 6

The European hernia society groin hernia classification: simple and easy to remember.

Classification of incisional hernias of the abdominal wall

An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique.

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Contributors

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Article

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