Delphi consensus statement for understanding and managing the subcostal hernia: subcostal hernias collaborative report (scholar study)

• DOI: 10.1007/s10029-024-02963-8
• Publication Date: 2024-02-16T20:02:38Z
• Authors: S. J. Baig; G. V. Kulkarni; P. Priya; M. Y. Afaque; J. Bueno-Lledo; S. Chintapatla; A. de Beaux; J. A. Gandhi; M. A. Garcia Urena; T. M. Hammond; D. Lomanto; R. Liu; A. Mehta; M. Miserez; A. Montgomery; S. Morales-conde; C. Palanivelu; E. M. Pauli; S. A. Rege; Y. Renard; M. Rosen; D. L. Sanders; V. K. Singhal; D. A. J. Slade; O. J. Warren; S. Wijerathne
• Keywords: Statement (logic)

Abstract Aim Subcostal hernias are categorized as L1 and frequently involve M1, M2, L2 sites. The literature on subcostal hernias comprises poor-quality retrospective reviews of small heterogenous cohorts, unsurprisingly leading to no consensus or guidelines. Given the limited literature, we planned for a modified Delphi consensus to establish consensus regarding the definition, characteristics, and surgical aspects of managing subcostal hernias (SCH). Materials and Methods It was a four-phase Delphi study reflecting the widely accepted model, consisting of the phases: 1. Creating a steering panel and a query. 2. Building an expert panel. 3. Executing the Delphi rounds. 4. Analyzing, presenting, and reporting the results. More than 70% of agreement was defined as a consensus statement. Results The 22 experts who agreed to participate in this Delphi process for Subcostal Hernias (SCH) comprised 7 UK surgeons, 6 mainland European surgeons, 4 Indians, 3 from the USA, and 2 from Southeast Asia. This Delphi study on subcostal hernias achieved consensus on the following areas – definition, use of mesh in elective cases; the retromuscular position with strong discouragement for onlay mesh; use of macroporous medium-weight polypropylene mesh; use of the subcostal incision over midline incision if there is no previous midline incision; TAR over ACST; defect closure where MAS is used; transverse suturing over vertical suturing for closure of circular defects; and use of peritoneal flap when necessary. Conclusion This Delphi consensus defines subcostal hernias and gives insight into the incision, dissection plane, mesh placement, mesh type, and mesh fixation for these hernias.