Table 1.

Summary of the consensus standard protocol for laparoscopic onlay mesh augmentation in incisional hernia repair.

General considerations

1. Use of a classification to improve the possibility of comparing different populations/studies

2. Separation of the two entities “Ventral Hernia” and “Incisional Hernia”

3. Standardized operative technique (see surgical technique)

4. Standardized use of medical products (see surgical technique)

5. Technique of “bridging” is limited to hernia sizes up to a maximum of 10 cm

6. Technique of “gap closure” is limited to hernia sizes up to a maximum of 10 cm

7. Perform a Health Care Research Study

Surgical technique

1. Preoperative estimation of hernia classification by physical examination and/or ultrasound and/or CT scan/MRI according to EHS guidelines

2. Access by mini-laparotomy or optical trocar

3. Capnoperitoneum up to 20 mmHg (see cardiac and respiratory function)

4. Three trocar technique, additional trocars to specify

5. Adhesiolysis/preparation of the spatium recii or the Lig. teres hepatis to insure mesh overlap of 5 cm

6. Resection of hernia sac (recommendation)

7. Measurement of hernia size/defect size under low pressure capnoperitoneum (≤8 mmgH) according to EHS guidelines

8. Calculating of mesh (Physiomesh™, CE marked) size with overlap of 5 cm (gap + overlap)

9. Arming of mesh with one suture (nonabsorbable) each at the edges of the mesh (transfascial fixation of mesh)

10. Alternative to “bridging”: “gap closure” with nonabsorbable sutures according to Chelala [4], calculation of mesh size as mentioned above

11. Positioning of the mesh in low pressure capnoperitoneum during fixation (≤8 mmHg)

12. Transfascial fixation of mesh with the four nonabsorbable sutures at the edges of the mesh (epifascial nodes, see 9.)

13. Fixation of mesh by SecureStrap™ (CE marked) in double crown technique (outer line: distance to the edges 0.5 cm, distance between tacs 2 cm, inner line: distance 1 cm to gap edge, distance between tacs 2 cm)

14. Transfascial closure of trocar incisions >5 mm

15. Standardized postoperative analgesia based on NRS, medication according to WHO scheme