A Ventral Hernia Management Pathway; A "Getting It Right First Time" approach to Complex Abdominal Wall Reconstruction.

Autor:	Parker SG; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Joyner J; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Thomas R; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Van Dellen J; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Mohamed S; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Jakkalasaibaba R; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Blake H; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Shanmuganandan A; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Albadry W; Plastics Surgery Department, St George's University Hospitals NHS Foundation Trust, London, UK., Panascia J; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Gray W; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK., Vig S; The Abdominal Wall Unit, Croydon University Hospital, Thornton Heath, London, UK.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2024 Jun; Vol. 90 (6), pp. 1714-1726. Date of Electronic Publication: 2024 Apr 08.
DOI:	10.1177/00031348241241650
Abstrakt:	Introduction: Abdominal wall reconstruction (AWR) is an emerging specialty, involving complex multi-stage operations in patients with high medical and surgical risk. At our hospital, we have developed a growing interest in AWR, with a commitment to improving outcomes through a regular complex hernia MDT. An MDT approach to these patients is increasingly recognized as the path forward in management to optimize patients and improve outcomes. Methods: We conducted a literature review and combined this with our experiential knowledge of managing these cases to create a pathway for the management of our abdominal wall patients. This was done under the auspices of GIRFT (Getting It Right First Time) as a quality improvement project at our hospital. Results: We describe, in detail, our current AWR pathway, including the checklists and information documents we use with a stepwise evidence and experience-based approach to identifying the multiple factors associated with good outcomes. We explore the current literature and discuss our best practice pathway. Conclusion: In this emerging specialty, there is limited guidance on the management of these patients. Our pathway, the "Complex Hernia Bundle," currently provides guidance for our abdominal wall team and may well be one that could be adopted/adapted by other centers where challenging hernia cases are undertaken. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Thomas R declares conflicts of interest not directly related to the submitted work: consultant adviser for TELA BIO.
Databáze:	MEDLINE
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