Table 4.

Consensus statements: role of multidisciplinary team and decision-making

Strong recommendations (> 80% agreement) Surgeons managing patients with AWH should have access to an MDT (local or virtual) (87%) Running an MDT meeting on a regular basis provides structure for innovation in AWR—an opportunity for surgical and clinical development and good clinical governance (87.1%) Running an MDT meeting on a regular basis provides a stratified structure for documentation of decision making—protecting surgeons and patients (81.2%) AWH MDT must include: – An experienced gastrointestinal surgeon (91%) – An experienced AWR surgeon—plastic surgeon/general surgeon (97%) – An expert in radiology (94%) – Dietary service/access to a dietary service (94%) – Prehabilitation or physiotherapy service/access to a prehabilitation or dietary service (94%) AWH MDT discussion must include hernia characteristics: – Hernia size (85%) – Hernia location (88%) – Loss of domain (94%) – Skin integrity (91%) AWH MDT discussion must include operative technique: – Requirement for mesh (82%) – Type of mesh to be used (80%) – Requirement for component separation (82%) – Need for reconstructive surgery, i.e., flap reconstruction (91%) – Need for concurrent procedure, i.e., stoma reversal/adhesiolysis (94%) – Need for botulinum toxin (87%) Critical care/intensive care beds must be available if needed for all patients with AWH (97%)

Weak recommendations (75-79% agreement) AWH MDT discussion must include operative technique: – Required dissection planes (75%) – Relevant muscle bulk and integrity (79%)

Percentage agreement shown in parentheses. AWH, abdominal wall incisional hernia; MDT, multidisciplinary team; AWR, abdominal wall repair.