title: Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected].
abstract: BACKGROUND
  The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues.
  
  
  METHODS
  The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence") was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group.
  
  
  CONCLUSIONS
  The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.
authors.affiliation: Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Via Faggiana 1668, 04100, Latina, LT, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
authors.forename: Fabio Cesare
authors.initials: FC
authors.lastname: Campanile
authors.forename: Luis
authors.initials: L
authors.lastname: Sanchez
authors.forename: Graziano
authors.initials: G
authors.lastname: Ceccarelli
authors.forename: Armando
authors.initials: A
authors.lastname: Antinori
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.forename: Stefano
authors.initials: S
authors.lastname: Olmi
authors.forename: Giovanni Carlo
authors.initials: GC
authors.lastname: Ferrari
authors.forename: Diego
authors.initials: D
authors.lastname: Cuccurullo
authors.forename: Paolo
authors.initials: P
authors.lastname: Baccari
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Agresta
authors.forename: Nereo
authors.initials: N
authors.lastname: Vettoretto
authors.forename: Micaela
authors.initials: M
authors.lastname: Piccoli
mesh_terms: D003245:Consensus Statements as Topic; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000592:standards*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D010535:Laparoscopy / Q000592:standards*; D013526:Surgical Mesh