Page 197 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Description of the hernia variables, operative procedure and mesh variables
The literature dealing with the treatment of abdominal wall hernias would bene t from using a common standard for description of the hernias themselves, the operation performed and the mesh materials used. The European Hernia Society has previously published classi cations for inguinal and ventral hernias(20, 21). Moreover during the development of the EuraHS platform for registration of ventral hernias many de nitions and recommendations for describing variables of interest were proposed by consensus amongst the EuraHS working group members(1). A general recommendation of the consensus meeting in Palermo is to use these existing classi cations and terminologies to describe the hernia patients included in a study.
Hernia variables
It is recommended to use the EHS classi cations for inguinal and ventral hernias. Primary ventral hernias and incisional ventral hernias should be distinguished and classi ed accordingly. The hernia size of ventral hernias is preferably an intra-operative measurement and the width and length will be described in centimetres (cm) as the mean and the standard deviation. If the hernia defect surface is reported, the method of calculation of the defect size in cm2 should be given. By multiplying width and length, the true hernia defect size is smaller than the rectangle calculated and thus this value is an overestimation of the true abdominal wall defect size. Alternatively the formula of an ellipse can be used to get a better estimation of the true hernia defect size. For calculating the real surface area of a hernia defect or several defects of an incisional hernia many measurements are needed and calculations dependent on the form of the defect. Ammaturo and Bassi have published a method for calculating the wall defect surface and compare it to the surface of the anterior abdominal wall(22). This method involves the use of transparent paper, a computer scanner and software to calculate the exact surface. For routine use in surgical practice this is not practical.
In order to classify the dimensions of an abdominal wall hernia the consensus is to use the terminology proposed in the previous classi cations. For primary ventral hernias three groups are created using the hernia defect diameter: small (<2 cm), medium (≥ 2 - 4 cm) and large (≥ 4 cm). For incisional hernias, there is not a common standard yet. The consensus panel recommends using the EHS classi cation and thus the width of the incisional hernia is the
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Recommendations IH research
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