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

L. C. L. van den Hil*, E. H. H. Mommers, J. W. A. M. Bosmans, S. Morales-Conde, Gomez-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-PuchnerM. H. F. Schreinemacher, N. D. Bouvy

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)2935–2943
Number of pages9
JournalWorld Journal of Surgery
Issue number9
Publication statusPublished - 4 Jul 2020




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