Definitions for loss of domain: an International Delphi Consensus of expert surgeons

Samuel G. Parker*, Steve Halligan, Mike K. Liang, Filip E. Muysoms, Gina L. Adrales, Adam Boutall, Andrew C. de Beaux, Ulrich A. Dietz, Celia M. Divino, Mary T. Hawn, Todd B. Heniford, Joon P. Hong, Nabeel Ibrahim, Kamal M. F. Itani, Lars N. Jorgensen, Agneta Montgomery, Salvador Morales-Conde, Yohann Renard, David L. Sanders, Neil J. SmartJared J. Torkington, Alastair C.J. Windsor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Citations (Scopus)
12 Downloads (Pure)


Background: No standardized written or volumetric definition exists for ‘loss of domain’ (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri- and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons. Methods: A Delphi study involving 20 internationally recognized abdominal wall reconstruction (AWR) surgeons was performed. Four written and two volumetric definitions of LOD were identified via systematic review. Panelists completed a questionnaire that suggested these definitions as standardized definitions of LOD. Consensus on a preferred term was pre-defined as achieved when selected by ≥80% of panelists. Terms scoring <20% were removed. Results: Voting commenced August 2018 and was completed in January 2019. Written definition: During Round 1, two definitions were removed and seven new definitions were suggested, leaving nine definitions for consideration. For Round 2, panelists were asked to select all appealing definitions. Thereafter, common concepts were identified during analysis, from which the facilitators advanced a new written definition. This received 100% agreement in Round 3. Volumetric definition: Initially, panelists were evenly split, but consensus for the Sabbagh method was achieved. Panelists could not reach consensus regarding a threshold LOD value that would preclude surgery. Conclusions: Consensus for written and volumetric definitions of LOD was achieved from 20 internationally recognized AWR surgeons. Adoption of these definitions will help standardize the use of LOD for both clinical and academic activities.

Original languageEnglish
Pages (from-to)1070-1078
Number of pages9
JournalWorld Journal of Surgery
Issue number4
Publication statusPublished - 1 Apr 2020

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


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