Current practice patterns in ventral hernia management: A survey of experts in hernia surgery

Julie L Holihan, MD1, Zeinab M Alawadi, MD, MS1, Juan R Flores-Gonzalez, MD1, Erik P Askenasy, MD2, Conrad Ballecer, MD3, Hui Sen Chong, MD4, Matthew I Goldblatt, MD5, Jacob A Greenberg, MD6, John A Harvin, MD1, Jerrod N Keith, MD4, Robert G Martindale, MD7, Sean Orenstein, MD7, Bryan Richmond, MD8, J. Scott Roth, MD9, Paul Szotek, MD10, Shirin Towfigh, MD11, Shawn Tsuda, MD12, Khashayar Vaziri, MD13, Mike K Liang, MD1. 1University of Texas Health Science Center at Houston, 2Baylor College of Medicine, 3Center for Minimally Invasive and Robotic Surgery, 4University of Iowa, 5Medical College of Wisconsin, 6University of Wisconsin, 7Oregon Health and Science University, 8West Virginia University, 9University of Kentucky, 10Indiana University Health, 11Beverly Hills Hernia Center, 12Univeristy of Nevada School of Medicine, 13George Washington University

Background: The management of patients with ventral hernias can pose a significant clinical challenge. This study characterizes the opinions and self-reported practice patterns of a group of expert hernia surgeons.

Methods: A panel of was assembled, including members of the already established Ventral Hernia Outcomes Collaborative and these members nominated additional surgeons with expertise in hernia care. Ten rounds of email questionnaires were sent to the panelists evaluating self-reported practice patterns, factors impacting surgical decision-making, and technical preferences.

Results: All sixteen surgeons completed the 10 surveys.  Of these, 13 (81%) are in academic practice and 3 (19%) are in private practice.  Fourteen (88%) teach residents.  Specialties represented include general surgery, plastic surgery, and minimally invasive surgery.  The surgeons reported a median (range) of 6 (1-25) years in practice.  Substantial discrepancy existed among surgeons including areas of patient selection, surgical decision-making, and technique.  The only areas of unanimous agreement were not performing elective repairs in current smokers, routine mesh reinforcement of elective ventral incisional hernias, routinely performing primary fascial closure, not using prophylactic antibiotics while drains are in place, and not currently placing prophylactic mesh.

Conclusions: There are wide variations in practice patterns among expert surgeons who perform ventral hernia repair. Increasing the quality of available research, expanding efforts of dissemination and implementation of high-quality data, and development of consensus guidelines are needed.

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