title: Definition of giant ventral hernias: Development of standardization through a practice survey.
abstract: BACKGROUND
  Giant ventral hernias represent a real handicap for patients and constitute a challenge for surgeons. European Hernia Society classification defines all ventral hernia over 10 cm in the same group. However, this group represents different clinical entities with numerous therapeutic possibilities, and no standardized recommendation has been made. The objective of our work was to define consensual criteria that define giant ventral hernias requiring specific management and determine management modalities.
  
  
  METHODS
  A national survey consisting of 21 questions was proposed through a secure, anonymous internet interface and on a voluntary basis to all surgeons practising in France involved in care of patients affected by giant ventral hernias.
  
  
  RESULTS
  For more than 68% of respondents, loss of domain and a hernia volume greater than 30% of abdominal volume were mandatory to define giant ventral hernias. Pre-operative screening should include abdominal CT scan, functional respiratory exploration, and a cardiology consultation for 98%, 71% and 50% of the respondents respectively. Respiratory and cutaneous preparations were systematically proposed before surgery by 91% and 56% of respondents. Regarding surgical techniques, none has gained the support of the majority of respondents. However, 71% of respondents use a non-resorbable mesh in retro muscular position for more than 70% of their patients treated for giant ventral hernias.
  
  
  CONCLUSIONS
  Giant ventral hernias could be defined as ventral hernia larger than 10 cm with loss of domain. A specific management is advocated.
authors.affiliation: Service de chirurgie générale, digestive et endocrinienne, CHU Lyon Sud, Hospices civils de Lyon, France; EMR 3738, Université de médecine Lyon Sud Charles Mérieux, Université Lyon 1, France. Electronic address: guillaume.passot@chu-lyon.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Passot
authors.affiliation: EMR 3738, Université de médecine Lyon Sud Charles Mérieux, Université Lyon 1, France; Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Villeneuve
authors.affiliation: Service de chirurgie digestive et oncologique, CHU d'Amiens, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Sabbagh
authors.affiliation: Service de chirurgie générale, digestive et endocrinienne, CHU de Reims, France.
authors.forename: Yohann
authors.initials: Y
authors.lastname: Renard
authors.affiliation: Service de chirurgie digestive et oncologique, CHU d'Amiens, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.affiliation: Service de chirurgie digestive et oncologique, CHU d'Amiens, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verhaeghe
authors.affiliation: Service de chirurgie générale, digestive et endocrinienne, CHU de Reims, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.affiliation: Service de chirurgie générale, digestive et endocrinienne, CHU de Reims, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Palot
authors.affiliation: Service de chirurgie générale, digestive et endocrinienne, CHU Lyon Sud, Hospices civils de Lyon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Vaudoyer
authors.affiliation: Service de chirurgie générale, digestive et endocrinienne, CHU Lyon Sud, Hospices civils de Lyon, France; EMR 3738, Université de médecine Lyon Sud Charles Mérieux, Université Lyon 1, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
authors.affiliation: Service de chirurgie générale, digestive et endocrinienne, CHU Lyon Sud, Hospices civils de Lyon, France; EMR 3738, Université de médecine Lyon Sud Charles Mérieux, Université Lyon 1, France.
authors.forename: Eddy
authors.initials: E
authors.lastname: Cotte
mesh_terms: D000328:Adult; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
keywords: Giant ventral hernia; Standardize; Survey