EHS Guidelines on the Management of Primary Ventral and Incisional Hernias Under Emergency Conditions
EHS · 2026 · Europe
Source and licence
- Authors
- Cesare Stabilini, Alexis Theodorou, Maciej Pawlak et al.
- Title
- EHS Guidelines on the Management of Primary Ventral and Incisional Hernias Under Emergency Conditions
- Journal
- Journal of Abdominal Wall Surgery, 2026
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC13044802
Licence statement of the original publication
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Implications for Researchers
- We recommend conducting matched, multicentre studies to ensure adequate statistical power and to obtain precise effect estimates.
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.
Contents of the original publication
The section headings of the original.
- Introduction
- Materials and Methods
- Steering Group
- Guideline Panel
- Evidence Review Teams
- Project Development and Meetings
- Health Questions
- Targeted Users
- Definitions
- ICAP Planes
- Protocol and Amendments
- Rating the Importance of Outcomes and Setting Minimal Important Differences
- Search Strategy
- Study Selection and Data Extraction
- Statistical Analysis
- Risk of Bias
- Certainty of Evidence
- Evidence-To-Decision Framework and Recommendations
- Direction and Strength of Recommendations
- Results
- Recommendations
- Discussion
- Implications for Policymakers
- Implications for Healthcare Professionals
- Implications for Patients
- Implications for Researchers
- Barriers and Facilitators
- Monitoring
- Validity Period
- Updates
- Conclusion
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