@article{b48c92057b6a463ba811984fa7a245c8,
title = "International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair",
abstract = "Background: Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including {\textquoteleft}inlay{\textquoteright}, {\textquoteleft}sublay{\textquoteright} and {\textquoteleft}underlay{\textquoteright}, can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. Methods: A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed. Results: Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms {\textquoteleft}onlay{\textquoteright}, {\textquoteleft}inlay{\textquoteright}, {\textquoteleft}preperitoneal{\textquoteright} and {\textquoteleft}intraperitoneal{\textquoteright}. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for {\textquoteleft}anterectus{\textquoteright}, {\textquoteleft}interoblique{\textquoteright}, {\textquoteleft}retro-oblique{\textquoteright} and {\textquoteleft}retromuscular{\textquoteright}. Default consensus was achieved for the {\textquoteleft}retrorectus{\textquoteright} and {\textquoteleft}transversalis fascial{\textquoteright} planes. Conclusion: Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.",
author = "Parker, {S. G.} and S. Halligan and Liang, {M. K.} and Muysoms, {F. E.} and Adrales, {G. L.} and A. Boutall and {de Beaux}, {A. C.} and Dietz, {U. A.} and Divino, {C. M.} and Hawn, {M. T.} and Heniford, {T. B.} and Hong, {J. P.} and N. Ibrahim and Itani, {K. M.F.} and Jorgensen, {L. N.} and A. Montgomery and S. Morales-Conde and Y. Renard and Sanders, {D. L.} and Smart, {N. J.} and Torkington, {J. J.} and Windsor, {A. C.J.}",
note = "Funding Information: This work was funded by the UK National Institute for Health Research (NIHR) (grant RfPB PB-PG-0816-20005) and Allergan (Dublin, Ireland). Neither funder was involved in the planning, methodology, analysis or write-up of the research. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the National Health Service, NIHR or Department of Health. S.H. was also supported by the NIHR University College London Hospitals Biomedical Research Centre. A.C.J.W. declares conflicts of interest not directly related to the submitted work: consultant adviser for TELA BIO; educational grants and speaker for BARD, LifeCell and Cook. B.A. declares conflicts of interest not related to the submitted work: travel grants from Ethicon, Bard and Medtronic; consultancy work for Medtronic. A.C.d.B declares conflicts of interest not directly related to the submitted work: speaker for Bard BD and Medtronic; trainer for Bard BD. T.B.H. declares conflicts of interest not directly related to the submitted work: consultancy work for W. L. Gore, Stryker Corporation, Allergan. L.N.J. declares conflicts of interest not directly related to the submitted work: educational grants from Bard BD and Medtronic. A.M. declares conflicts of interest not directly related to the submitted work: speaker for Bard BD. S.M.-C. declares conflicts of interest not directly related to the submitted work: speaker for Bard BD; educational work for Medtronic, Ethicon, Storz Medical, Olympus, Stryker Corporation, W. L. Gore; consultancy work for Dipro Medical. F.E.M. declares conflicts of interest not directly related to the submitted work: consultancy work for Medtronic, Intuitive Surgical, CMR Surgical, DynaMesh; educational grants from Medtronic and DynaMesh; speaker for Bard BD. Y.R. declares conflicts of interest not directly related to the submitted work: educational grants from Bard BD, Hartmann. D.L.S. declares conflicts of interest not directly related to the submitted work: educational grant, speaker's fee and fee for postmarketing surveillance from Medtronic; speaker's fee and consultant for Bard BD. N.J.S. declares conflicts of interest not directly related to the submitted work: educational and speaker grants from W. L. Gore and Medtronic. J.J.T. declares conflicts of interest not directly related to the submitted work: speaker and consultant for Medtronic. Disclosure: The authors declare no other conflict of interest. Funding Information: This work was funded by the UK National Institute for Health Research (NIHR) (grant RfPB PB‐PG‐0816‐20005) and Allergan (Dublin, Ireland). Neither funder was involved in the planning, methodology, analysis or write‐up of the research. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the National Health Service, NIHR or Department of Health. S.H. was also supported by the NIHR University College London Hospitals Biomedical Research Centre. A.C.J.W. declares conflicts of interest not directly related to the submitted work: consultant adviser for TELA BIO; educational grants and speaker for BARD, LifeCell and Cook. B.A. declares conflicts of interest not related to the submitted work: travel grants from Ethicon, Bard and Medtronic; consultancy work for Medtronic. A.C.d.B declares conflicts of interest not directly related to the submitted work: speaker for Bard BD and Medtronic; trainer for Bard BD. T.B.H. declares conflicts of interest not directly related to the submitted work: consultancy work for W. L. Gore, Stryker Corporation, Allergan. L.N.J. declares conflicts of interest not directly related to the submitted work: educational grants from Bard BD and Medtronic. A.M. declares conflicts of interest not directly related to the submitted work: speaker for Bard BD. S.M.‐C. declares conflicts of interest not directly related to the submitted work: speaker for Bard BD; educational work for Medtronic, Ethicon, Storz Medical, Olympus, Stryker Corporation, W. L. Gore; consultancy work for Dipro Medical. F.E.M. declares conflicts of interest not directly related to the submitted work: consultancy work for Medtronic, Intuitive Surgical, CMR Surgical, DynaMesh; educational grants from Medtronic and DynaMesh; speaker for Bard BD. Y.R. declares conflicts of interest not directly related to the submitted work: educational grants from Bard BD, Hartmann. D.L.S. declares conflicts of interest not directly related to the submitted work: educational grant, speaker's fee and fee for postmarketing surveillance from Medtronic; speaker's fee and consultant for Bard BD. N.J.S. declares conflicts of interest not directly related to the submitted work: educational and speaker grants from W. L. Gore and Medtronic. J.J.T. declares conflicts of interest not directly related to the submitted work: speaker and consultant for Medtronic. Disclosure : The authors declare no other conflict of interest. Publisher Copyright: {\textcopyright} 2019 BJS Society Ltd Published by John Wiley & Sons Ltd",
year = "2020",
month = feb,
day = "1",
doi = "10.1002/bjs.11400",
language = "English (US)",
volume = "107",
pages = "209--217",
journal = "British Journal of Surgery",
issn = "0007-1323",
publisher = "John Wiley and Sons Ltd",
number = "3",
}