What question did this study set out to answer?

The aim is to present standardized guidelines for the emergency management of primary ventral and incisional hernias.

March 14, 2026Journal of Abdominal Wall Surgery0 citationsOpen Access

EHS Guidelines on the Management of Primary Ventral and Incisional Hernias Under Emergency Conditions

CSCesare StabiliniOspedale Policlinico San Martino ATAlexis TheodorouSpace Hellas (Greece)MPMaciej PawlakGolden Jubilee National Hospital

Key Points

The aim is to present standardized guidelines for the emergency management of primary ventral and incisional hernias.
Developed by the European Hernia Society through AGREE-S, GRADE, and GIN standards
Guideline panel includes surgeons and patient partners to address key health questions
A systematic review informed the recommendations
Consensus was reached on all recommendations using an evidence-to-decision framework
Recommendations favor mesh-based repair over primary suture repair for defect closure, regardless of contamination grade
Laparoscopic intraperitoneal mesh and open onlay mesh are advised
For large defects unsuitable for closure, a staged approach without immediate mesh repair is recommended
Adherence to guidelines may improve patient outcomes and standardize management of hernias

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.

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