What defines an incisional hernia as 'complex': results from a Delphi consensus endorsed by the European Hernia Society (EHS)
Abstract
A 'complex' hernia is often referred to in the published literature, yet has not been clearly defined to date. 'Large' and 'giant' may also be used to describe a complex incisional hernia indirectly. Meanwhile, a 'complex hernia' in reference to the technical surgical challenge of abdominal wall repair is different from a 'complex patient', the latter relating more to a patient's mental or physical health. Several risk scores have been developed and described in the literature2,4-6. Although hernia dimensions and defect characteristics alongside patient co-morbidities have demonstrated some correlation with poor surgical outcomes, postoperative complications alone should not define complexity.
Slater et al. subsequently published criteria to define a complex abdominal wall hernia, comprising four categories: size and location, contamination/soft tissue condition, patient history/risk factors, and clinical scenario; three severity classes were defined, namely minor, moderate, and major. Although often referenced in publications, this definition has not been found to be an efficient working definition of a complex incisional hernia. Furthermore, with increasing preoperative adjuncts and operative strategies available to manage incisional hernia, and increased surgical specialization in the field, a revised consensus definition is required.