the Management of Ventral Hernia: - Annexes | EHC

"last update: 10 March 2026" Download Guideline

- Annexes

Table 1. Primary ventral hernia classification,⁽¹⁷⁾

Primary ventral

hernia classification

Diameter (cm).

Midline Epigastric

Umbilical

Small Medium Large

< 2 cm 2 – 4 cm > 4 cm

Lateral Spigelian

Lumbar

Table 2. Incisional hernia classification,⁽¹⁷⁾

Midline Sub-xiphoid M1

Epigastric M2

Umbilical M3

Infra-umbilical M4

Suprapubic M5

Lateral Subcostal L1

Flank L2

Iliac L3

Lumbar L4

Recurrent incisional hernia Yes No

Length (cm)

Width (cm) < 4cm W1

4 - 10 cm W2

>4 cm W3

Table 3. Incisional hernia anatomical location borders,⁽¹⁷⁾

Borders of Borders of

Midline area Lateral area

______________________________________________

Cranial Xiphoid process Costal margin

Caudal Pubic bone Inguinal ligament

Lateral Linea semilunaris Lumbar region

Medial Linea semilunaris

Table 4. M and L zones for incisional hernia, ⁽¹⁷⁾

Medial			Lateral
M1	Sub-xiphoidal	Xiphoid to 3 cm caudally	L1	Subcostal	Between the costal margin and a horizontal line 3 cm above the umbilicus
M2	Epigastric	3 cm below the xiphoid to 3 cm above the umbilicus	L2	Flank	Latera to the rectal sheath in the area 3 cm above and below the umbilicus
M3	Umbilical	3 cm above to 3 cm below the umbilicus	L3	Iliac	Between a horizontal line 3 cm below the umbilicus and the inguinal region
M4	Infra-umbilical	3 cm below the umbilicus To 3 cm above the pubis	L4	Lumbar	Latero dorsal to the anterior axillary line
M5	Supra-pubic	Pubic symphysis to 3 cm Cranially

Table 5. Quality and Significance of the four levels of evidence in GRADE

Table 6. Factors that determine How to upgrade or downgrade the quality of evidence

Table 7: Recommendations for mesh placed in the EXTRAPERITONEAL POSITION, ⁽¹⁷⁾.

VHWG 2013 grade¹¹ Risk Factors Recommended mesh Mesh to consider Contra-indicated mesh

Low risk Composite, Biologic,

Grade 1: Low risk No history of wound Plain mesh Fully absorbable PTFE

infections

Co-morbidities:

Grade 2: Smoker, obese, Composite, Biologic,

Intermediate risk diabetic, COPD, Plain mesh Fully absorbable PTFE

previous wound

infection

Grade 3A Clean contaminated No mesh Plain Mesh*, Fully Composite, PTFE

absorbable, Biologic

Grade 3B Contaminated No mesh Fully absorbable, Composite, PTFE

Biologic

Grade 3C Dirty contaminated No mesh Fully absorbable Composite, Biologic,

PTFE

*It is recommended that if proceeding with a mesh repair after enterotomy, it should be large pore and placed in the retro-rectus position which is away from the peritoneal cavity and skin and is a well vascularized plane.

the Management of Ventral Hernia

"last update: 10 March 2026" Download Guideline

- Annexes

Table 1. Primary ventral hernia classification,⁽¹⁷⁾

Table 2. Incisional hernia classification,⁽¹⁷⁾

Table 3. Incisional hernia anatomical location borders,⁽¹⁷⁾

Table 4. M and L zones for incisional hernia, ⁽¹⁷⁾

Table 5. Quality and Significance of the four levels of evidence in GRADE

Table 6. Factors that determine How to upgrade or downgrade the quality of evidence

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the Management of Ventral Hernia

"last update: 10 March 2026" Download Guideline

- Annexes

Table 1. Primary ventral hernia classification, (17)

Table 2. Incisional hernia classification, (17)

Table 3. Incisional hernia anatomical location borders, (17)

Table 4. M and L zones for incisional hernia, (17)

Table 5. Quality and Significance of the four levels of evidence in GRADE Table 6. Factors that determine How to upgrade or downgrade the quality of evidence

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تواصل معنا

Find us on

Table 1. Primary ventral hernia classification,⁽¹⁷⁾

Table 2. Incisional hernia classification,⁽¹⁷⁾

Table 3. Incisional hernia anatomical location borders,⁽¹⁷⁾

Table 4. M and L zones for incisional hernia, ⁽¹⁷⁾

Table 5. Quality and Significance of the four levels of evidence in GRADE

Table 6. Factors that determine How to upgrade or downgrade the quality of evidence