Protocol for EHS Guideline on Treatment of Ventral and Incisional Hernias in Emergency

Abstract

Background: Emergency presentations of ventral and incisional hernias are common and associated with significantly higher morbidity and mortality than elective procedures. Despite their frequency, clinical guidance on managing acutely complicated hernias in emergency settings remains limited and heterogeneous. Objective: This protocol outlines the development of an evidence-based clinical guideline by the European Hernia Society (EHS) to support general and emergency surgeons in treating acutely complicated ventral and incisional hernias in adults. Methods: Developed according to AGREE-S and GRADE methodologies, this guideline will address seven key clinical questions concerning the use of mesh, surgical approach, and technique based on clinical contamination status and anatomical considerations. A steering group of hernia surgery experts and methodologists leads the project, supported by two independent evidence review teams. Patient input will be obtained via structured surveys to incorporate values and preferences. Systematic literature reviews, evidence-to-decision frameworks, and consensus meetings will guide the formulation of recommendations, with strength and direction defined according to GRADE standards. Discussion: This is the first EHS guideline specifically targeting the emergency management of incisional and ventral hernias. By addressing urgent clinical decisions through a structured, transparent, and inclusive process, it aims to reduce variability in care, improve outcomes, and serve as a resource for clinical practice and future research. The guideline will be published open access and monitored for implementation and updates based on emerging evidence.