Top

Published in:

01-09-2020 | Original Scientific Report

META Score: An International Consensus Scoring System on Mesh-Tissue Adhesions

Authors: L. C. L. van den Hil, E. H. H. Mommers, J. W. A. M. Bosmans, S. Morales-Conde, V. Gómez-Gil, K. LeBlanc, A. Vanlander, E. Reynvoet, F. Berrevoet, S. Gruber-Blum, E. Altinli, C. R. Deeken, R. H. Fortelny, J. W. Greve, K. Chiers, R. Kaufmann, J. F. Lange, U. Klinge, M. Miserez, A. H. Petter-Puchner, M. H. F. Schreinemacher, N. D. Bouvy

Published in: World Journal of Surgery | Issue 9/2020

Abstract

Background

Currently, the lack of consensus on postoperative mesh-tissue adhesion scoring leads to incomparable scientific results. The aim of this study was to develop an adhesion score recognized by experts in the field of hernia surgery.

Methods

Authors of three or more previously published articles on both mesh-tissue adhesion scores and postoperative adhesions were marked as experts. They were queried on seven items using a modified Delphi method. The items concerned the utility of adhesion scoring models, the appropriateness of macroscopic and microscopic variables, the range and use of composite scores or subscores, adhesion-related complications and follow-up length. This study comprised two questionnaire-based rounds and one consensus meeting.

Results

The first round was completed by 23 experts (82%), the second round by 18 experts (64%). Of those 18 experts, ten were able to participate in the final consensus meeting and all approved the final proposal. From a total of 158 items, consensus was reached on 90 items. The amount of mesh surface covered with adhesions, tenacity and thickness of adhesions and organ involvement was concluded to be a minimal set of variables to be communicated separately in each future study on mesh adhesions.

Conclusion

The MEsh Tissue Adhesion scoring system is the first consensus-based scoring system with a wide backing of renowned experts and can be used to assess mesh-related adhesions. By including this minimal set of variables in future research interstudy comparability and objectivity can be increased and eventually linked to clinically relevant outcomes.

Luijendijk RW, de Lange DC, Wauters CC et al (1996) Foreign material in postoperative adhesions. Ann Surg 223(3):242–248CrossRef

Turza KC, Butler CE (2012) Adhesions and meshes: synthetic versus bioprosthetic. Plast Reconstr Surg 130(5 Suppl 2):206s–213s. https://doi.org/10.1097/PRS.0b013e3182638d48 CrossRefPubMed

ten Broek RP, Issa Y, van Santbrink EJ et al (2013) Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ 347:f5588. https://doi.org/10.1136/bmj.f5588 CrossRefPubMedPubMedCentral

Zhu LM, Schuster P, Klinge U (2015) Mesh implants: an overview of crucial mesh parameters. World J Gastrointest Surg 7(10):226–236. https://doi.org/10.4240/wjgs.v7.i10.226 CrossRefPubMedPubMedCentral

Schreinemacher MH, van Barneveld KW, Dikmans RE et al (2013) Coated meshes for hernia repair provide comparable intraperitoneal adhesion prevention. Surg Endosc 27(11):4202–4209. https://doi.org/10.1007/s00464-013-3021-5 CrossRefPubMed

Peeters E, van Barneveld KW, Schreinemacher MH et al (2013) One-year outcome of biological and synthetic bioabsorbable meshes for augmentation of large abdominal wall defects in a rabbit model. J Surg Res 180(2):274–283. https://doi.org/10.1016/j.jss.2013.01.025 CrossRefPubMed

Gruber-Blum S, Brand J, Keibl C et al (2015) The impact of hydrophobic hernia mesh coating by omega fatty acid on atraumatic fibrin sealant fixation. Hernia J Hernias Abdom Wall Surg 19(4):651–657. https://doi.org/10.1007/s10029-014-1304-y CrossRef

Diamond MP, Linsky CB, Cunningham T et al (1987) A model for sidewall adhesions in the rabbit: reduction by an absorbable barrier. Microsurgery 8(4):197–200CrossRef

de Oliveira N, Paschoa AF, Crespo CC et al (1981) Use of the combination of a nitrofurazone derivative with polyethylene glycols in the prevention of the formation of peritoneal adhesions—experimental study. Arq Gastroenterol 18(2):54–59PubMed

10.

Zuhlke HV, Lorenz EM, Straub EM et al (1990) Pathophysiology and classification of adhesions. Langenbecks Archiv fur Chirurgie Supplement II, Verhandlungen der Deutschen Gesellschaft fur Chirurgie Deutsche Gesellschaft fur Chirurgie Kongress, pp 1009–1016

11.

Dubcenco E, Assumpcao L, Dray X et al (2009) Adhesion formation after peritoneoscopy with liver biopsy in a survival porcine model: comparison of laparotomy, laparoscopy, and transgastric natural orifice transluminal endoscopic surgery (NOTES). Endoscopy 41(11):971–978. https://doi.org/10.1055/s-0029-1215229 CrossRefPubMed

12.

Claudio RH, Diogo Filho A, Mamede Filho DO (2006) Peritoneostomy with latex coated polypropylene: experimental study in rats. Acta cirurgica brasileira/Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 21(6):402–408CrossRef

13.

Schreinemacher M, Henatsch D, van Barneveld K et al (2010) The need for standardised animal models and scoring systems in assessing mesh biocompatibility. Hernia J Hernias Abdom Wall Surg 14(3):335–336. https://doi.org/10.1007/s10029-010-0642-7 CrossRef

14.

Dalkey NC (1967) Delphi. RAND Corporation, Santa Monica

15.

Fitch K, Bernstein SJ, Aguilar MD et al (2001) The RAND/UCLA appropriateness method user's manual. RAND Corporation, Santa Monica

16.

Vogels RRM, Kaufmann R, van den Hil LCL et al (2017) Critical overview of all available animal models for abdominal wall hernia research. Hernia J Hernias Abdom Wall Surg 21(5):667–675. https://doi.org/10.1007/s10029-017-1605-z CrossRef

17.

Moossdorff M, van Roozendaal LM, Strobbe LJ et al (2014) Maastricht Delphi consensus on event definitions for classification of recurrence in breast cancer research. J Natl Cancer Inst. https://doi.org/10.1093/jnci/dju288 CrossRefPubMedPubMedCentral

18.

Bellon JM, Contreras LA, Bujan J et al (1996) Effect of phosphatidylcholine on the process of peritoneal adhesion following implantation of a polypropylene mesh prosthesis. Biomaterials 17(14):1369–1372CrossRef

19.

Garrard CL, Clements RH, Nanney L et al (1999) Adhesion formation is reduced after laparoscopic surgery. Surg Endosc 13(1):10–13. https://doi.org/10.1007/s004649900887 CrossRefPubMed

20.

Diamond MP, Wexner SD, diZereg GS et al (2010) Adhesion prevention and reduction: current status and future recommendations of a multinational interdisciplinary consensus conference. Surg Innov 17(3):183–188. https://doi.org/10.1177/1553350610379869 CrossRefPubMed

21.

ten Broek RP, Strik C, Issa Y et al (2013) Adhesiolysis-related morbidity in abdominal surgery. Ann Surg 258(1):98–106. https://doi.org/10.1097/SLA.0b013e31826f4969 CrossRefPubMed

22.

Losanoff JE, Richman BW, Jones JW (2002) Entero-colocutaneous fistula: a late consequence of polypropylene mesh abdominal wall repair: case report and review of the literature. Hernia J Hernias Abdom Wall Surg 6(3):144–147. https://doi.org/10.1007/s10029-002-0067-z CrossRef

23.

van den Beukel BA, de Ree R, van Leuven S et al (2017) Surgical treatment of adhesion-related chronic abdominal and pelvic pain after gynaecological and general surgery: a systematic review and meta-analysis. Hum Reprod Update 23(3):276–288. https://doi.org/10.1093/humupd/dmx004 CrossRefPubMed

24.

Matthews BD, Mostafa G, Carbonell AM et al (2005) Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite prosthetic mesh. J Surg Res 123(2):227–234. https://doi.org/10.1016/j.jss.2004.08.012 CrossRefPubMed

25.

Anderson JM, Rodriguez A, Chang DT (2008) Foreign body reaction to biomaterials. Semin Immunol 20(2):86–100. https://doi.org/10.1016/j.smim.2007.11.004 CrossRefPubMed

26.

Gomez-Gil V, Garcia-Honduvilla N, Pascual G et al (2010) Peritoneal adhesion formation and reformation tracked by sequential laparoscopy: optimizing the time point for adhesiolysis. Surgery 147(3):378–391. https://doi.org/10.1016/j.surg.2009.10.011 CrossRefPubMed

Title: META Score: An International Consensus Scoring System on Mesh-Tissue Adhesions
Authors: L. C. L. van den Hil
E. H. H. Mommers
J. W. A. M. Bosmans
S. Morales-Conde
V. Gómez-Gil
K. LeBlanc
A. Vanlander
E. Reynvoet
F. Berrevoet
S. Gruber-Blum
E. Altinli
C. R. Deeken
R. H. Fortelny
J. W. Greve
K. Chiers
R. Kaufmann
J. F. Lange
U. Klinge
M. Miserez
A. H. Petter-Puchner
M. H. F. Schreinemacher
N. D. Bouvy
Publication date: 01-09-2020
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 9/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05568-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

META Score: An International Consensus Scoring System on Mesh-Tissue Adhesions

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2020

Effect of Surgical Approach on Node Harvest in Gastrectomy: Analysis of the National Cancer Database

Expression of Pancreatic Stone Protein is Unaffected by Trauma and Subsequent Surgery in Burn Patients

Is Early Initiation of Adjuvant Chemotherapy Beneficial for Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy and Radical Surgery?

Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short-term Outcomes and Morbidity

Standardized Method of the Thiersch Operation for the Treatment of Fecal Incontinence

The Diagnostic Utility of Splenectomy in Idiopathic Splenomegaly