• S G Parker, S Halligan, M K Liang, F E Muysoms, G L Adrales, A Boutall, A C de Beaux, U A Dietz, C M Divino, M T Hawn, T B Heniford, J P Hong, N Ibrahim, Itani K M F KMF Department of General Surgery, Veterans Affairs Boston Health Care System, Boston and Harvard Universities, West Roxbury, Massachusetts, USA., L N Jorgensen, A Montgomery, S Morales-Conde, Y Renard, D L Sanders, N J Smart, J J Torkington, and Windsor A C J ACJ Abdominal Wall Unit, University College London Hospital, London, UK..
• Abdominal Wall Unit, University College London Hospital, London, UK.
• Br J Surg. 2020 Feb 1; 107 (3): 209-217.

BackgroundNomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including 'inlay', 'sublay' and 'underlay', 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.MethodsA 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.ResultsVoting 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 'onlay', 'inlay', 'preperitoneal' and 'intraperitoneal'. 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 'anterectus', 'interoblique', 'retro-oblique' and 'retromuscular'. Default consensus was achieved for the 'retrorectus' and 'transversalis fascial' planes.ConclusionConsensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.

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