The Story of EHS-GREPA 1979–2014

April 1979, Paris, France: under a mild drizzle, a small group of surgeons are gathered in a humble teaching area at the Avicenne Hospital in Bobigny, Paris.

They have been invited by Professor Jean-Paul Chevrel together with other surgeons: Professors Jean Rives, René Stoppa, Jean-Henri Alexandre, Paul-Louis Fagniez, Jacques Hureau, Jacques Perissat, Jean Escat, Daniel Rignault, together with some of their pupils, such as J.B. Flament, J.P. Palot, J.F. Delattre and a few other physicians, anesthetists and officials as Pr Loygue nominated as President, all motivated by a joint surgical interest, a passion for hernia surgery, with the aim not only to share but also improve techniques and ideas on the subject of herniology.

Jean Rives and Jean-Henri Alexandre, both anatomists and surgeons, have been early educated since 1958–1960 in the use of prosthetic material in incisional hernia surgery by Pr Bourgeon at the French University of Algiers, about the same period as Usher (1958) and Koontz first publications on that topic.

Impressed with the good results of mesh repairs, they developed their own experience with those very controversial techniques: at that time the recurrence rates after inguinal hernia and incisional hernia repair, everywhere all over the world, were more than 25 and 45 %, respectively. Rives published in 1967 the use of Dacron mesh in inguinal hernia repair and in 1968 the results of the use of large Mersilene-meshes in ventral hernia repair using the sublay technique. In multiple papers he demonstrated the role and importance of the prosthetic repairs even in inguinal hernia repair.

Upon these ideas they thought and enrolled an enthusiastic J.P. Chevrel who then decided with others present founding surgeons to organize the first hernia-meeting, birth of the first scientific society for herniology. This little group of French surgeons intended to rise to the challenges: improving the rather disappointing results at that time of abdominal wall surgery—at this time a underestimated discipline lacking recognition—as well as promoting it as an important branch of surgery in its own right. These pioneer-surgeons founded the “Groupe de Recherche et d’Etudes de la Paroi Abdominale” (GREPA) with J.P. Chevrel as Head and Secretary General, present at this responsibility until 1998.

The registered goal of the GREPA-Research Group was “to study and teach all the anatomical, physiological and therapeutical problems upon the abdominal wall”.

Since the inauguration of GREPA in 1979, J.P. Chevrel organized an annual hernia congress at the Bobigny Hospital (Paris). Each year a different topic was chosen and the results of these meetings were published later in a Yearbook:

1980:

Prevention of incisional hernias,

1981:

Wall tumors,

1982:

Chronic pain after inguinal hernia repair,

1983:

Inguinal hernias,

1984:

Diaphragm,

1985:

Incisional hernias,

1991:

Prosthesis and glues.

He published in the yearbook “GREPA” (Lab. Bruneau) the results of inguinal hernia repair with a preperitoneal mesh prosthesis (Rives procedure) and the first excellent long-term results of sublay technique for incisional hernia repair, 1968–1973 (Don Acquaviva, Rives).

Under the Rives-concept, René Stoppa published in 1975 a new technique for bilateral inguinal hernias with a Giant Prosthesis Reinforcement of Visceral Sac (GPRVS), today known as the Stoppa procedure. Chevrel published a collective book about HERNIAS (Springer edit) and the Onlay technique in 1979, Alexandre published in 1983 the Rives modified technique with parietalization of the cord and an unsplitted mesh. These techniques more or less modified due to multiple types of available prostheses are at the basis of current and laparoscopic techniques.

Since the early 1980s GREPA attracted more and more the interest and the participation of numerous surgeons from different countries. A fruitful collaboration started with an Italian group of surgeons: F. Corcione, E. Mandala, G. Califano, P. Bocchi, G. Trivellini; followed by new European hernia enthusiasts such as H. Troidl (Germany), M. Kux (Austria), M. Hidalgo Pascual and J.L. Porero (Spain), H.B. Devlin (UK), E. Nilsson (Sweden), J. Himpens (Belgium), R.K.J. Simmermacher (Netherlands) and many others.

The activities of the group developed in a friendly atmosphere, producing more and more scientific knowledge with critical evaluation of new techniques, comparisons between them, performing trials and analysis of publications.

The initial small French group developed into an international one, with meetings organized in different countries, soon attractive for US surgeons such as G. Wantz, A. Gilbert, L. Nyhus, R. Read, M. Deysine, P. Amid, R. Bendavid, I. Rutkow and A. Robbins. They came frequently to visit different French departments of General and Hernia Surgery (in Reims the Department of Surgery of Rives and Flament, in Amiens the department of Stoppa, in Paris my department of Surgery at Broussais University Hospital). They shared and used our French mesh-techniques and attended each year our Congress.

In 1997, on the model of GREPA-EHS, the American Hernia Society (AHS) was founded at the first US Hernia Congress in Miami, under the presidency of well-known friends: R. Bendavid, Ch. Filipi, R. Fitzgibbons, A. Gilbert, K. LeBlanc and R. Read.

In the same year, in 1997, J.P. Chevrel founded a journal dedicated to the abdominal wall, Hernia, published by Springer, in which he remained as Editor in Chief until 2001. This journal became the prestigious World Journal of Hernia and Abdominal Wall Surgery, the official organ of the EHS-GREPA and AHS, with successive co-editors: V. Schumpelick, R. Bendavid, Ch. Filipi, R. Fitzgibbons, A. Kingsnorth, M. Miserez.

J.P. Chevrel until his death in 2006, and the EHS-staff always stressed the importance of the quality of the publications, with critical peer review. Today this journal counts more than 1500 subscribers and presents with a growing impact factor (>2).

Thus many congresses in different European cities became the natural stage of an increasing international development of the GREPA group: 1993 in Milano (Prof. Trivellini), 1994 in Reims (Prof. Flament), 1995 in Palermo (Prof. Mandala), 1996 in Paris (Prof. Alexandre), 1997 in Napoli (Prof. Corcione), 1998 in Cologne (Prof. Troidl).

At the end of the first German Congress (Cologne 1998), the GREPA group takes its new name as European Hernia Society-GREPA: EHS-GREPA.

A new board and minutes were established in 1999, composed by a President, a General Secretary, a Treasurer, three secretaries for scientific research, education and website, one editor in chief for the Hernia journal. All board members are nominated for 3 years, with a vote for 2 possible mandates, and a President of the Permanent Advisory Committee. Since 1999, each year a different city is chosen to organize the annual European Congress with a responsible Congress-President. In 2014 the Board has been formed with specific functions to each member of the advisory committee (education, scientific, quality, web, congress) and the appointment of 20 new wings as advisory committees.

EHS became year after year a bigger international society with national Chapters. Little by little several foreign chapters were created and integrated within the EHS-GREPA: France, Italy, UK, Germany, Spain, Austria, Belgium, Greece, the Netherlands, Sweden, Turkey, Poland, and later Israel, Bulgaria, Hungary, Russia, Ukraine, Serbia, Czech Republic (19 in 2015) with participants from US, Australia, China. Singapore, Switzerland, Denmark, Cyprus, etc.

A new area started in 2000 with the decision to organize a joint meeting of the two hernia societies, EHS and AHS, in the spirit of celebrating the universality of abdominal wall surgery.

The first joint meeting was organized by R. Bendavid in 2000 in Toronto, the next one in London in 2003 organized by A. Kingsnorth, the third one in Boston by M. Deysine in 2006; the fourth one was organized in 2009 in Berlin by V. Schumpelick and J. Conze and the fifth in New York in 2012 organized by T. Heniford and S. Roll.

More and more the audience of EHS, under the authority of G. Campanelli, General Secretary for more than 14 years, became internationally known as a result of a contagious passion for the abdominal wall surgery through the world and through the numerous papers published in Hernia journal and different other journals, due for a big part to the worldwide use of different kinds of prosthesis in hernia repairs and to the birth and the diffusion of the laparoscopic surgery since 1990.

It should not be forgotten that the surgery of the abdominal wall is also an economic stake: approximately one million patients are operated every year in Europe for inguinal or incisional hernia. With time the aims in that surgery have been changing: at the beginning, the primary aim was a lower recurrence rate. Today the focus is far broader, the targets far more exciting: we need to reduce the rate of acute and chronic postoperative pain, to reduce hospital stays, to increase ambulatory surgery, to facilitate rapid return to work, an excellent quality of life and all that with affordable costs!

For the same objectives, the industry, under the requirements of our specialized units and with the pressure and collaboration of EHS, took the opportunity and started to develop multiple kinds of prosthesis (more than 200) composed in various textures, shapes and dimensions, either synthetic or biological as well as multiple and various means of fixation: sutures, staples, tacks and glues. Industry helped our Hernia-Society, under the proposals of our Scientific Committee, to realize multiple trials and randomized comparative studies, up to approach, as a research of the Graal, the “Golden technique”, the best or ideal prosthesis adapted to inguinal or incisional hernia repair.

This international diffusion of our ideas and publications, the growing status of Hernia surgery, the new vision about laparoscopic repairs, our friendship with colleagues and friends from Singapore, India, China, Indonesia and other Asian countries have been the impulse to the foundation of many hernia societies in different countries leading to the foundation of the Asia-Pacific-Hernia Society (APHS) in 2004, under the initiative of three friends and experimented pioneers: D. Lomanto (Singapore), P. Chowbey (India) and Son Zhang Ma (China).

In 2006, the fourth joint meeting in Berlin has been the first triple-conjoint meeting with the three Hernia Societies (EHS, AHS, APHS). It was a successful meeting with more than 2000 participants, sharing their experiences, their tasks, for an impartial evaluation of materials, techniques, results and projects.

Each society works and moves at its own pace and rhythm: EHS organized multiple annual congresses, and between the last: 2007 in Athens, 2008 in Sevilla, 2010 in Istanbul, 2011 in Ghent, 2013 in Gdansk, 2014 in Edinburgh—it is the 36th annual congress—and in the next future 2015 in Milan, 2016 in Rotterdam and 2017 in Vienna.

EHS has been invited at multiple congresses by the AHS and APHS in Beijing, New Delhi, where some EHS members have been nominated as Honorary Members: J.B. Flament, Jean-Henri Alexandre, V. Schumpelick, G. Campanelli, M. Miserez, R. Bittner. In 2008 was created the Australian Hernia Society (Austral) under the leadership of Pr Tran and in 2011 the Afro Middle East Hernia Society (AMEHS) under the leadership of Pr Maggiore.

Year after year, EHS published numerous prospective controlled trials and classifications (Classification of Inguinal Hernias, Classification of Incisional hernias, Classification of Parastomal Hernias, Guidelines for Inguinal Hernia Repairs, and soon: Guidelines for Parastomal-Hernia-Repairs). An ongoing project is the development of an EHS School of Hernia-Surgery.

If we look back on the past years, we can see a consistent advancement of the EHS, not only in terms of scientific input and results, but also in terms of friendship amongst hernia surgeons, not only within Europe but all over the world. All this would not have been achieved without the support of the many members of the board that have worked together in different formations over the years, that deserve the gratitude of the societies for their honorary work.

The development of the EHS will continue, getting more professional with the rising numbers of members. In April 2015 Pr Campanelli organized in Milan the first World Conference on Abdominal Wall Surgery as the three years joint Congress of the European Hernia Surgery with the  participation for the first time of the five Hernia societies: the European Hernia Society, the American Hernia Society, the Asia Pacific Hernia Society, the Australian Hernia Society and the Afro Middle East Hernia Society.

The European Hernia Society is very proud to have stimulated the international surgical community to give birth to numerous hernia societies all over the world that work together in a friendly cooperation, for the benefit of thousands and thousands of hernia patients on this planet.