EHS Guidelines on the Management of Primary Ventral and Incisional Hernias Under Emergency Conditions
Year: 2026
Type: article
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.
Authors: Cesare Stabilini, Alexis Theodorou, Maciej Pawlak, Stavros Antoniou, Frederik Berrevoet, Heather Bougard, Umberto Bracale, Sara Capoccia Giovannini, René Fortelny, Christine Gaarder, Miguel Angel Garcia-Urena, Katie Gilmore, Sergio Alejandro Gomez-Ochoa, Ferdinand Köckerling, Elisa Mäkäräinen, Salvador Morales-Conde, Francesca Pecchini, José Antonio Pereira Rodríguez, Andrea Carolina Quiroga-Centeno, Yohann Renard, Benoit Romain, Elena Schembari, Eva Deerenberg
Institutions: University of Genoa, National and Kapodistrian University of Athens, Hippocration General Hospital, Golden Jubilee National Hospital, University of Glasgow, European University Cyprus, Ghent University Hospital, University of Cape Town, Somerset Hospital, Federico II University Hospital, Sigmund Freud Privatuniversität Wien, Oslo University Hospital, University of Oslo, Universidad Francisco de Vitoria, Hospital Universitario del Henares, University Hospital Heidelberg, Fundación Cardiovascular de Colombia, Charité - Universitätsmedizin Berlin, Oulu University Hospital, Hospital Universitario Virgen Macarena, Hospital Quirónsalud Sagrado Corazón, Universidad de Sevilla, Azienda Ospedaliero-Universitaria di Modena, Hospital Del Mar, Parc de Salut, Municipal Institute for Medical Research, Hospital del Mar Research Institute, Universidad Industrial de Santander, Heidelberg University, Medizinische Fakultät Mannheim, Université de Reims Champagne-Ardenne, Hôpitaux Universitaires de Strasbourg, Royal Devon & Exeter NHS Foundation Trust, Royal Devon and Exeter Hospital, Sint Franciscus Gasthuis, Franciscus Vlietland
Language: English
Topic: Hernia repair and management
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,413
Funder: European Hernia Society
OpenAlex ID: W7134981002