EHS Guidelines on the Management of Primary Ventral and Incisional Hernias Under Emergency Conditions

Introduction Emergent primary ventral or incisional hernias (PVIHs) are a common cause of surgical admission, leading to significantly higher rates of morbidity and mortality compared to elective hernia repairs. Despite this, management varies widely due to a lack of evidence-based consensus. This article presents the new European Hernia Society (EHS) guidelines for the emergency treatment of adult patients with PVIH. Material and Methods This project was developed by the EHS Science Committee following AGREE-S, GRADE, and GIN standards. A guideline panel, composed of general and emergency surgeons along with patient partners, formulated seven key health questions addressing the surgical approach, mesh type and placement, and the management of defects of varying sizes and contamination levels to support general surgeons in their decision-making process. A systematic review was conducted, and recommendations were developed using a formal evidence-to-decision framework, ensuring consensus was reached on all recommendations. Results The guidelines expert panel provides recommendations for several clinical scenarios. For defects amenable to direct closure, mesh-based repair is suggested over primary suture repair, regardless of the contamination grade. Furthermore, a laparoscopic approach with intraperitoneal mesh, an open approach with onlay mesh placement, and the use of large-pore synthetic meshes are recommended. For large defects, not amenable to closure, a staged approach that avoids immediate mesh-based repair is suggested. Conclusion Adherence to these guidelines can help standardise the management of emergent PVIHs, potentially improving patient outcomes. The recommendations advocate for a “damage control” mindset, prioritising physiological stability over immediate definitive reconstruction. Further research is needed to address gaps in the current literature, particularly with regard to long-term recurrence rates and the specific protocols for managing these complex cases.

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Publication Details

Journal
Journal of Abdominal Wall Surgery
Published
2026-03-11
DOI
https://doi.org/10.3389/jaws.2026.16228
Primary Topic
Hernia repair and management
Type
article
Field-Weighted Citation Impact
0.00

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article

EHS Guidelines on the Management of Primary Ventral and Incisional Hernias Under Emergency Conditions

Katie Gilmore, Benoit Romain, Yohann Renard, Francesca Pecchini et al.
Journal of Abdominal Wall Surgery
Hernia repair and management
article

EHS Guidelines on the Management of Primary Ventral and Incisional Hernias Under Emergency Conditions

Katie Gilmore, Benoit Romain, Yohann Renard, Francesca Pecchini, Eva B. Deerenberg, Stavros A. Antoniou, Elena Schembari, Heather Bougard, Sergio Alejandro Gómez-ochoa, Cesare Stabilini, Christine Gaarder, Sara Capoccia Giovannini, René H. Fortelny, Jose Antonio Pereira Rodriguez, Ferdinand Köckerling, Alexis Theodorou, Salvador Morales-Conde, Umberto Bracale, Maciej Pawlak, Frederik Berrevoet, Elisa Mäkäräinen, Miguel Angel Garcia-Urena, Andrea Carolina Quiroga-Centeno
article en

Abstract

Introduction Emergent primary ventral or incisional hernias (PVIHs) are a common cause of surgical admission, leading to significantly higher rates of morbidity and mortality compared to elective hernia repairs. Despite this, management varies widely due to a lack of evidence-based consensus. This article presents the new European Hernia Society (EHS) guidelines for the emergency treatment of adult patients with PVIH. Material and Methods This project was developed by the EHS Science Committee following AGREE-S, GRADE, and GIN standards. A guideline panel, composed of general and emergency surgeons along with patient partners, formulated seven key health questions addressing the surgical approach, mesh type and placement, and the management of defects of varying sizes and contamination levels to support general surgeons in their decision-making process. A systematic review was conducted, and recommendations were developed using a formal evidence-to-decision framework, ensuring consensus was reached on all recommendations. Results The guidelines expert panel provides recommendations for several clinical scenarios. For defects amenable to direct closure, mesh-based repair is suggested over primary suture repair, regardless of the contamination grade. Furthermore, a laparoscopic approach with intraperitoneal mesh, an open approach with onlay mesh placement, and the use of large-pore synthetic meshes are recommended. For large defects, not amenable to closure, a staged approach that avoids immediate mesh-based repair is suggested. Conclusion Adherence to these guidelines can help standardise the management of emergent PVIHs, potentially improving patient outcomes. The recommendations advocate for a “damage control” mindset, prioritising physiological stability over immediate definitive reconstruction. Further research is needed to address gaps in the current literature, particularly with regard to long-term recurrence rates and the specific protocols for managing these complex cases.

Journal of Abdominal Wall SurgeryVol. 5
Sigmund Freud Privatuniversität Wien (AT), Universidad Industrial de Santander (CO), Oslo University Hospital (NO), University of Oslo (NO), Cal Poly Humboldt (US), European University Cyprus (CY), Heidelberg University (DE), Oulu University Hospital (FI), Somerset Hospital (ZA), Ghent University Hospital (BE), Royal Devon and Exeter Hospital (GB), Golden Jubilee National Hospital (GB), University Hospital Heidelberg (DE), Sint Franciscus Gasthuis (NL), Hospital Universitario Virgen Macarena (ES), Hospital Quirónsalud Sagrado Corazón (ES), Fundación Cardiovascular de Colombia (CO), Vivantes Klinikum (DE), Federico II University Hospital (IT), Hôpital Robert-Debré (FR), Parc de Salut (ES), Universidad de Santander (PA), Hôpitaux Universitaires de Strasbourg (FR), Franciscus Vlietland (NL), Hospital Universitario del Henares (ES), University Medical Centre Mannheim (DE), Hippocration General Hospital (GR), University of Glasgow (GB), University of Genoa (IT), National Operating Committee on Standards for Athletic Equipment (US), Université de Reims Champagne-Ardenne (FR)
European Hernia Society
Openalex Percentile: Top 26%
Hernia repair and management
DOIOpen Access PDFOpenAlex
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