title: Ventral Hernia Management: Expert Consensus Guided by Systematic Review.
abstract: To achieve consensus on the best practices in the management of ventral hernias (VH).
  
  
  
  Management patterns for VH are heterogeneous, often with little supporting evidence or correlation with existing evidence.
  
  
  
  A systematic review identified the highest level of evidence available for each topic. A panel of expert hernia-surgeons was assembled. Email questionnaires, evidence review, panel discussion, and iterative voting was performed. Consensus was when all experts agreed on a management strategy.
  
  
  
  Experts agreed that complications with VH repair (VHR) increase in obese patients (grade A), current smokers (grade A), and patients with glycosylated hemoglobin (HbA1C) ≥ 6.5% (grade B). Elective VHR was not recommended for patients with BMI ≥ 50 kg/m (grade C), current smokers (grade A), or patients with HbA1C ≥ 8.0% (grade B). Patients with BMI= 30-50 kg/m or HbA1C = 6.5-8.0% require individualized interventions to reduce surgical risk (grade C, grade B). Nonoperative management was considered to have a low-risk of short-term morbidity (grade C). Mesh reinforcement was recommended for repair of hernias ≥ 2 cm (grade A). There were several areas where high-quality data were limited, and no consensus could be reached, including mesh type, component separation technique, and management of complex patients.
  
  
  
  Although there was consensus, supported by grade A-C evidence, on patient selection, the safety of short-term nonoperative management, and mesh reinforcement, among experts; there was limited evidence and broad variability in practice patterns in all other areas of practice. The lack of strong evidence and expert consensus on these topics has identified gaps in knowledge where there is need of further evidence.
authors.affiliation: *University of Texas Health Science Center at Houston, Houston, TX †Veterans Affairs Boston Healthcare System, Boston University and Harvard Medical School, Boston, MA ‡Baylor College of Medicine, Texas Medical Center, Houston, TX §Center for Minimally Invasive and Robotic Surgery, Peoria, AZ ¶University of Iowa, Iowa City, IA ||Medical College of Wisconsin, Milwaukee, WI **University of Wisconsin, Madison, WI ††Oregon Health and Science University, Portland, OR ‡‡West Virginia University, Morgantown, WV §§University of Kentucky, Lexington, KY ¶¶Indiana University Health, Indianapolis, IN ||||Beverly Hills Hernia Center, Beverly Hills, CA ***University of Nevada School of Medicine, Las Vegas, NV †††George Washington University, Washington, DC.
authors.forename: Mike K
authors.initials: MK
authors.lastname: Liang
authors.forename: Julie L
authors.initials: JL
authors.lastname: Holihan
authors.forename: Kamal
authors.initials: K
authors.lastname: Itani
authors.forename: Zeinab M
authors.initials: ZM
authors.lastname: Alawadi
authors.forename: Juan R Flores
authors.initials: JR
authors.lastname: Gonzalez
authors.forename: Erik P
authors.initials: EP
authors.lastname: Askenasy
authors.forename: Conrad
authors.initials: C
authors.lastname: Ballecer
authors.forename: Hui Sen
authors.initials: HS
authors.lastname: Chong
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Goldblatt
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Greenberg
authors.forename: John A
authors.initials: JA
authors.lastname: Harvin
authors.forename: Jerrod N
authors.initials: JN
authors.lastname: Keith
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
authors.forename: Sean
authors.initials: S
authors.lastname: Orenstein
authors.forename: Bryan
authors.initials: B
authors.lastname: Richmond
authors.forename: John Scott
authors.initials: JS
authors.lastname: Roth
authors.forename: Paul
authors.initials: P
authors.lastname: Szotek
authors.forename: Shirin
authors.initials: S
authors.lastname: Towfigh
authors.forename: Shawn
authors.initials: S
authors.lastname: Tsuda
authors.forename: Khashayar
authors.initials: K
authors.lastname: Vaziri
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
mesh_terms: D003697:Delphi Technique; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D012307:Risk Factors; D013526:Surgical Mesh