I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya str., 8, b. 2, 119992, Moscow, Russia.
Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
Surg Endosc. 2019 Oct;33(10):3069-3139. doi: 10.1007/s00464-019-06907-7. Epub 2019 Jun 27.
In 2014, the International Endohernia Society (IEHS) published the first international "Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias." Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature.
For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included.
Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques-minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields.
Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.
国际疝学会（IEHS）于 2014 年发布了首份腹腔镜治疗腹壁前侧和切口疝的国际“指南”。指南反映了目前在诊断和治疗方面最佳的现有证据，并提供了有助于外科医生规范技术和提高治疗效果的建议。然而，科学是一个不断发展的领域。因此，指南需要定期更新，以跟上不断发展的文献。
为制定原始指南，使用牛津循证医学中心的分级方法对截至 2012 年发表的所有相关文献进行了分析。为本次更新，要求所有原作者评估 2012 年至 2017 年期间发表的文献，并相应地修改他们在初始指南中的陈述和建议。在两次共识会议（2017 年 10 月北京，2018 年 3 月科隆）上，对更新内容进行了陈述、讨论和确认。为避免重复，本文仅包括新的陈述或建议。因此，为了全面理解指南，必须同时阅读原始指南和现行指南。此外，还包括腹壁疝修复方面的新进展，如腹壁内的手术技术、松解手术（腹直肌松解、腹直肌前鞘分离）、肉毒杆菌毒素的应用以及机器人辅助修复方法。
由于患者数量的增加和手术技术的进一步发展，原发性和继发性腹壁疝的修复引起了越来越多外科医生的兴趣。而在 30 年前，疝相关出版物每年不超过 20 篇，而现在则增加了近 10 倍。近年来的特点是新技术的出现，如机器人辅助腹腔镜微创手术、完全腹膜外修补术、新型肌筋膜松解技术以优化大缺损的闭合以及用于放松腹壁的肉毒杆菌毒素。此外，还认识到同时存在腹直肌分离是复发的重要危险因素。尽管这些新技术的证据不足，但我们认为有必要在更新中纳入这些技术，以鼓励外科医生在这些领域开展研究。
指南是基于最佳现有证据的建议，旨在帮助外科医生提高日常工作质量。然而，科学是一个不断发展的过程，因此指南应每 3 年更新一次。然而，为了全面参考，建议同时阅读 2014 年发布的原始指南和更新内容。此外，本次更新还包括了 3 年前未知的技术。
