WSES guidelines for emergency repair of complicated abdominal wall hernias
World Journal of Emergency Surgery ,
Dec 2013
Massimo Sartelli , Federico Coccolini , Gabrielle H van Ramshorst , Giampiero Campanelli , Vincenzo Mandalà , Luca Ansaloni , Ernest E Moore , Andrew Peitzman , George Velmahos , Fredrick Moore , et al.
Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.
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WSES guidelines for emergency repair of complicated abdominal wall hernias
World Journal of Emergency Surgery
WSES guidelines for emergency repair of complicated abdominal wall hernias
Massimo Sartelli 0
Federico Coccolini
Gabrielle H van Ramshorst
Giampiero Campanelli
Vincenzo Mandal
Luca Ansaloni
Ernest E Moore
Andrew Peitzman
George Velmahos
Fredrick Alan Moore
Ari Leppaniemi
Clay Cothren Burlew
Walter Biffl
Kaoru Koike
Yoram Kluger
Gustavo P Fraga
Carlos A Ordonez
Salomone Di Saverio
Ferdinando Agresta
Boris Sakakushev
Igor Gerych
Imtiaz Wani
Michael D Kelly
Carlos Augusto Gomes
Mario Paulo Faro Jr
Korhan Taviloglu
Zaza Demetrashvili
Jae Gil Lee
Nereo Vettoretto
Gianluca Guercioni
Cristian Tran 0
Yunfeng Cui
Kenneth YY Kok
Wagih M Ghnnam
Ashraf El-Sayed Abbas
Norio Sato
Sanjay Marwah
Muthukumaran Rangarajan
Offir Ben-Ishay
Abdul Rashid K Adesunkanmi
Helmut Alfredo Segovia Lohse
Jakub Kenig
Stefano Mandal
Andrea Patrizi 0
Rodolfo Scib 0
Fausto Catena
0 Department of Surgery, Macerata Hospital , Macerata , Italy
Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.
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Introduction
A large number of abdominal hernias require emergency
surgery. However, these procedures are associated with
poor prognoses and a higher rate of post-operative
complications [1].
A World Society of Emergency Surgery (WSES)
Consensus Conference was held in Bergamo on July 2013, during
the 2nd Congress of the World Society of Emergency Sur
gery with the goal of defining recommendations for
emergency repair of abdominal wall hernias in adults. This
document represents the executive summary of the
consensus conference approved by a WSES expert panel.
Abdominal hernias may be classified as groin hernias
(femoral and inguinal) and ventral hernias (umbilical,
epigastric, spigelian and incisional).
An incarcerated hernia may be defined as a hernia in
which the contents have become irreducible due to a
narrow opening in the abdominal wall or adhesions within the
cavity. Intestinal obstruction can complicate an incarcerated
hernia. In contrast, a strangulated hernia is one in which
the blood supply to the contents of the hernia (eg
omentum, bowel) s becomes compromised [2].
Strangulated hernias remain a significant challenge, as
they are sometimes difficult to diagnose purely by physical
examination yet require urgent surgical intervention. Early
surgical intervention of a strangulated hernia with
obstruction is crucial as delayed diagnosis can lead to bowel
resection with longer recovery and its attendant complications.
Strangulated hernias can have serious deleterious effects
such as, bowel obstruction, bacterial translocation, and
intestinal wall necrosis (potentially resulting in bowel
perforation). It poses a significant risk to emergency hernia repair,
as there is an increased incidence of surgical field
contamination, leading to high rates of post-operative infection and
probably recurrence.
Bacteria inherently colonize all surgical wounds, but only
a fraction of these contaminates ultimately lead to infection.
In most patients infection does not occur because innate
host defences are able to eliminate microbes at the surgical
site. However, there is some evidence that the implantation
of foreign materials, such as prosthetic mesh, may lead to a
decreased threshold for infection [3].
While many factors can influence surgical wound healing
and post-operative infection, bacterial burden is the most
significant risk factor. Wounds are classified according to
the likelihood and degree of wound contamination at the
time of operation. Classifications include: clean wounds,
clean-contaminated wounds, contaminated wounds, and
dirty or infected wounds [4].
The pathogens involved in an infection depend on the
type of surgery. In an aseptic surgical procedure,
Staphylococcus aureus is a common source of infection, either from
the patients own skin flora or surrounding environment.
Surgeons can minimize the risk of infection and associated
complications by routinely employing site-specific spectrum
antibiotic prophylaxis.
In clean-contaminated, contaminated, and dirty
surgical procedures, the polymicrobial aerobic and anaerobic
flora closely resemble the normal endogenous microflora
of the gastrointestinal (GI) tract and are the most
frequently observed pathogens. The contaminating
pathogens in GI surgery include gram-negative bacilli (e.g.,
Escherichia coli) and gram-positive microbes, such as
enterococci and anaerobic organisms. A classification
scheme has been demonstrated in multiple studies to
predict the relative probability that a given wound will
bec (...truncated)
This is a preview of a remote PDF: http://www.wjes.org/content/pdf/1749-7922-8-50.pdf
Massimo Sartelli, Federico Coccolini, Gabrielle H van Ramshorst, Giampiero Campanelli, Vincenzo Mandalà, Luca Ansaloni, Ernest E Moore, Andrew Peitzman, George Velmahos, Fredrick Moore, Ari Leppaniemi, Clay Burlew, Walter Biffl, Kaoru Koike, Yoram Kluger, Gustavo P Fraga, Carlos A Ordonez, Salomone Di Saverio, Ferdinando Agresta, Boris Sakakushev, Igor Gerych, Imtiaz Wani, Michael D Kelly, Carlos Gomes, Mario Faro, Korhan Taviloglu, Zaza Demetrashvili, Jae Lee, Nereo Vettoretto, Gianluca Guercioni, Cristian Tranà, Yunfeng Cui, Kenneth YY Kok, Wagih M Ghnnam, Ashraf El-Sayed Abbas, Norio Sato, Sanjay Marwah, Muthukumaran Rangarajan, Offir Ben-Ishay, Abdul Rashid K Adesunkanmi, Helmut Segovia Lohse, Jakub Kenig, Stefano Mandalà, Andrea Patrizi, Rodolfo Scibé, Fausto Catena.
WSES guidelines for emergency repair of complicated abdominal wall hernias ,
World Journal of Emergency Surgery,
2013, pp. 50, 8, DOI: 10.1186/1749-7922-8-50