Department of Minimal Access Surgery, Belle Vue Clinic, Digestive Surgery Clinic, Bellevue Hospital Kolkata, Kolkata, 700017, India.
Department of Colorectal Surgery, Broomfield Hospital (Mid and South Essex NHS Trust), Essex, UK.
Hernia. 2024 Jun;28(3):839-846. doi: 10.1007/s10029-024-02963-8. Epub 2024 Feb 16.
Subcostal hernias are categorized as L1 based on the European Hernia Society (EHS) classification and frequently involve M1, M2, and L2 sites. These are common after hepatopancreatic and biliary surgeries. The literature on subcostal hernias mostly comprises of retrospective reviews of small heterogenous cohorts, unsurprisingly leading to no consensus or guidelines. Given the limited literature and lack of consensus or guidelines for dealing with these hernias, we planned for a Delphi consensus to aid in decision making to repair subcostal hernias.
We adopted a modified Delphi technique to establish consensus regarding the definition, characteristics, and surgical aspects of managing subcostal hernias (SCH). It was a four-phase Delphi study reflecting the widely accepted model, consisting of: 1. Creating a query. 2. Building an expert panel. 3. Executing the Delphi rounds. 4. Analysing, presenting, and reporting the Delphi results. More than 70% of agreement was defined as a consensus statement.
The 22 experts who agreed to participate in this Delphi process for Subcostal Hernias (SCH) comprised 7 UK surgeons, 6 mainland European surgeons, 4 Indians, 3 from the USA, and 2 from Southeast Asia. This Delphi study on subcostal hernias achieved consensus on the following areas-use of mesh in elective cases; the retromuscular position with strong discouragement for onlay mesh; use of macroporous medium-weight polypropylene mesh; use of the subcostal incision over midline incision if there is no previous midline incision; TAR over ACST; defect closure where MAS is used; transverse suturing over vertical suturing for closure of circular defects; and use of peritoneal flap when necessary.
This Delphi consensus defines subcostal hernias and gives insight into the consensus for incision, dissection plane, mesh placement, mesh type, and mesh fixation for these hernias.
根据欧洲疝学会（EHS）分类，肋缘下疝分为 L1 型，常涉及 M1、M2 和 L2 部位。这些疝常在肝胰胆和胆道手术后发生。肋缘下疝的文献主要包括对小异质性队列的回顾性综述，这并不奇怪，因为没有达成共识或指南。鉴于这些疝的文献有限，且缺乏共识或处理这些疝的指南，我们计划进行德尔菲共识，以帮助做出修复肋缘下疝的决策。
我们采用改良德尔菲技术就肋缘下疝（SCH）的定义、特征和手术处理方面达成共识。这是一个四阶段的德尔菲研究，反映了广泛接受的模型，包括：1. 创建查询。2. 建立专家小组。3. 执行德尔菲回合。4. 分析、呈现和报告德尔菲结果。超过 70%的一致意见被定义为共识声明。
22 名同意参与肋缘下疝（SCH）德尔菲过程的专家包括 7 名英国外科医生、6 名欧洲大陆外科医生、4 名印度人、3 名来自美国和 2 名来自东南亚。这项关于肋缘下疝的德尔菲研究就以下方面达成共识：在择期病例中使用网片；强烈不建议使用前肌膜位的网片；使用大孔中重量聚丙烯网片；如果没有先前的中线切口，则使用肋缘下切口而不是中线切口；TAR 优于 ACST；如果使用 MAS，则进行缺损闭合；对于圆形缺损的闭合，采用横向缝合优于垂直缝合；必要时使用腹膜瓣。
这项德尔菲共识定义了肋缘下疝，并深入了解了这些疝的切口、解剖平面、网片放置、网片类型和网片固定的共识。
