EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair

F Muysoms, G Campanelli, G G Champault, A C DeBeaux, U A Dietz, J Jeekel, U Klinge, F Köckerling, V Mandala, A Montgomery, S Morales Conde, F Puppe, R K J Simmermacher, M Śmietański, M Miserez, F Muysoms, G Campanelli, G G Champault, A C DeBeaux, U A Dietz, J Jeekel, U Klinge, F Köckerling, V Mandala, A Montgomery, S Morales Conde, F Puppe, R K J Simmermacher, M Śmietański, M Miserez

Abstract

Background: Although the repair of ventral abdominal wall hernias is one of the most commonly performed operations, many aspects of their treatment are still under debate or poorly studied. In addition, there is a lack of good definitions and classifications that make the evaluation of studies and meta-analyses in this field of surgery difficult.

Materials and methods: Under the auspices of the board of the European Hernia Society and following the previously published classifications on inguinal and on ventral hernias, a working group was formed to create an online platform for registration and outcome measurement of operations for ventral abdominal wall hernias. Development of such a registry involved reaching agreement about clear definitions and classifications on patient variables, surgical procedures and mesh materials used, as well as outcome parameters. The EuraHS working group (European registry for abdominal wall hernias) comprised of a multinational European expert panel with specific interest in abdominal wall hernias. Over five working group meetings, consensus was reached on definitions for the data to be recorded in the registry.

Results: A set of well-described definitions was made. The previously reported EHS classifications of hernias will be used. Risk factors for recurrences and co-morbidities of patients were listed. A new severity of comorbidity score was defined. Post-operative complications were classified according to existing classifications as described for other fields of surgery. A new 3-dimensional numerical quality-of-life score, EuraHS-QoL score, was defined. An online platform is created based on the definitions and classifications, which can be used by individual surgeons, surgical teams or for multicentre studies. A EuraHS website is constructed with easy access to all the definitions, classifications and results from the database.

Conclusion: An online platform for registration and outcome measurement of abdominal wall hernia repairs with clear definitions and classifications is offered to the surgical community. It is hoped that this registry could lead to better evidence-based guidelines for treatment of abdominal wall hernias based on hernia variables, patient variables, available hernia repair materials and techniques.

Figures

Fig. 1
Fig. 1
Logo of EuraHS: European registry of abdominal wall hernias
Fig. 2
Fig. 2
Screenshot of the dialogue for data input into the EuraHS database. A blue background of a question indicates that it has not been answered yet
Fig. 3
Fig. 3
The triple-P triangle of abdominal wall hernia repair
Fig. 4
Fig. 4
EuraHS ventral hernia model for registration and classification of abdominal wall hernias based on the localisation of the hernia
Fig. 5
Fig. 5
EuraHS terminology of mesh positions during ventral hernia repair
Fig. 6
Fig. 6
EuraHS quality-of-life score for pre- and post-operative assessment of patients with ventral abdominal wall hernias: EuraHS-QoL

References

    1. Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg. 2004;91:1372–1376. doi: 10.1002/bjs.4502.
    1. Bisgaard T, Kehlet H, Bay-Nielsen MB, Iversen MG, Wara P, Rosenberg J, Friis-Andersen HF, Jorgensen LN. Nationwide study of early outcomes after incisional hernia repair. Br J Surg. 2009;96:1452–1457. doi: 10.1002/bjs.6728.
    1. Helgstrand F, Rosenberg J, Bay-Nielsen M, Friis-Andersen H, Wara P, Jorgensen LN, Kehlet H, Bisgaard T. Establishment and initial experiences from the Danish Ventral Hernia Database. Hernia. 2010;14:131–135. doi: 10.1007/s10029-009-0592-0.
    1. Bisgaard T, Kehlet H, Bay-Nielsen M, Iversen MG, Rosenberg J, Jørgensen LN. A nationwide study on readmission, morbidity, and mortality after umbilical and epigastric hernia repair. Hernia. 2011;15:541–546. doi: 10.1007/s10029-011-0823-z.
    1. Hawn MT, Snyder CW, Graham LA, Gray SH, Finan KR, Vick CC. Hospital-level variability in incisional hernia repair technique affects patient outcomes. Surgery. 2011;149:185–191. doi: 10.1016/j.surg.2010.07.001.
    1. Snyder CW, Graham LA, Vick CC, Gray SH, Finan KR, Hawn MT. Patient satisfaction, chronic pain, and quality of life after elective incisional hernia repair: effects of recurrence and repair technique. Hernia. 2011;15:123–129. doi: 10.1007/s10029-010-0750-4.
    1. Mason RJ, Moazzez A, Sohn HJ, Berne TV, Katkhouda N. Laparoscopic versus open anterior abdominal wall hernia repair: 30-Day morbidity and mortality using the ACS-NSQIP database. Ann Surg. 2011;254:641–652. doi: 10.1097/SLA.0b013e31823009e6.
    1. Baumeister J, Reutelshoefer J, Puppe F (2011) KnowWE: a semantic wiki for knowledge engineering. In: Applied intelligence. 10.1007/s10489-010-0224-5
    1. Freiberg M, Mitlmeier J, Baumeister J, Puppe F (2010) Knowledge system prototyping for usability engineering. In: Proceedings of the LWA-2010 (special track on knowledge management)
    1. Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, Hoeferlin A, Kingsnorth AN, Mandala V, Palot JP, Schumpelick V, Simmermacher RK, Stoppa R, Flament JB (2007) The European hernia society groin hernia classification: simple and easy to remember. Hernia 11:113–116
    1. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403
    1. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RKJ, Simons MP, Śmietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional ventral hernias. Hernia 13:407–414
    1. American Society of Anesthesiologists. ASA Physical Status Classification Score. (2011) In: ASA Relative Value Guide 2011
    1. Sørensen LT, Hemmingsen UB, Kirkeby LT, Kallehave F, Jørgensen LN. Smoking is a risk factor for incisional hernia. Arch Surg. 2005;140:119–123. doi: 10.1001/archsurg.140.2.119.
    1. Sorensen LT, Friis E, Jorgensen T, Vennits B, Andersen BR, Rasmussen GI, Kjaergaard J. Smoking is a risk factor for recurrence of groin hernia. World J Surg. 2002;26:397–400. doi: 10.1007/s00268-001-0238-6.
    1. Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg. 2002;89:534–545. doi: 10.1046/j.1365-2168.2002.02083.x.
    1. Dietz UA, Hamelmann W, Winkler MS, Debus ES, Malafaia O, Czeczko NG, Thiede A, Kuhfuss I. An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique. J Plast Reconstr Aesthet Surg. 2007;60:383–388. doi: 10.1016/j.bjps.2006.10.010.
    1. Winkler MS, Gerharz E, Dietz UA. Overview and evolving strategies of ventral hernia repair. (in German) Urologe. 2008;47:740–747. doi: 10.1007/s00120-008-1678-5.
    1. Garner JS. CDC guideline for prevention of surgical wound infections. Infect Control. 1985;7:193–200.
    1. Luijendijk RW, Hop WC, van den van den Tol MP, de Lange DC, Braaksma MM, Ijzermans JN, Boelhouwer RU et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398
    1. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240:578–583.
    1. Klinge et al. New classification of meshes for abdominal wall repair. This article is submitted to Hernia at this moment
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. doi: 10.1097/.
    1. Morales-Conde S et al (2012) A new classification of seroma after laparoscopic ventral hernia repair. This article also is now submitted to Hernia
    1. Tse GH, Stutchfield BM, Duckworth AD, de Beaux AC, Tulloh B. Pseudo-recurrence following laparoscopic ventral and incisional hernia repair. Hernia. 2010;14:583–587. doi: 10.1007/s10029-010-0709-5.
    1. Schoenmaeckers EJ, Wassenaar EB, Raymakers JT, Rakic S. Bulging of the mesh after laparoscopic repair of ventral and incisional hernias. JSLS. 2010;14:541–546. doi: 10.4293/108680810X12924466008240.
    1. Aasvang E, Kehlet H. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the international association for the study of pain, subcommittee on taxonomy. Pain Suppl. 1986;3:S1–S226.
    1. Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA. Cooperative hernia study. Pain in the postrepair patient. Ann Surg. 1996;224:598–602. doi: 10.1097/00000658-199611000-00003.
    1. Poelman MM, Schellekens JF, Langenhorst BL, Schreurs WH. Health-related quality of life in patients treated for incisional hernia with an onlay technique. Hernia. 2010;14:237–242. doi: 10.1007/s10029-009-0619-6.
    1. Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW. Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg. 2008;206(4):638–644. doi: 10.1016/j.jamcollsurg.2007.11.025.
    1. Website of the European Hernia Society;
    1. Hinssen P (2010) The new normal. Uitgeverij Lannoo nv, Tielt, Belgium.
    1. Kaafarani HM, Hur K, Campasano M, Reda DJ, Itani KM. Classification and valuation of postoperative complications in a randomized trial of open versus laparoscopic ventral herniorrhaphy. Hernia. 2010;14:231–235. doi: 10.1007/s10029-009-0593-z.
    1. Dindo D, Hahnloser D, Clavien PA. Quality assessment in surgery: riding a lame horse. Ann Surg. 2010;251:766–771. doi: 10.1097/SLA.0b013e3181d0d211.
    1. Loos MJA, Houterman S, Scheltinga MRM, Roumen RMH. Evaluating postherniorraphy groin pain: visual analogue or verbal rating scale? Hernia. 2008;12:147–151. doi: 10.1007/s10029-007-0301-9.
    1. Muysoms FE, Bontinck J, Pletinckx P. Complications of mesh devices for intraperitoneal umbilical hernia repair: a word of caution. Hernia. 2011;15:463–468. doi: 10.1007/s10029-010-0692-x.
    1. European union directive 93/42/EEC on medical devices.
    1. Conclusions of the chair of a high-level health conference in Brussels, March 22nd 2011.

Source: PubMed

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