Endorsement of the HerniaSurge guidelines by the Americas Hernia Society
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We must congratulate the HerniaSurge group on their Herculean effort of providing expertly-culled, evidence-based recommendations on the management of groin hernia, a significant, worldwide disease.
The exhaustive review of groin hernia management covers many new and unique topics. The section on registries bears special mention. The adage that “the best repair is the one the surgeon performs best” is valid and we should draw upon these individual experiences. Although randomized trials provide the highest grade of recommendation in these guidelines, many clinical questions have only weak recommendations or remain entirely unanswered, leaving surgeons with expert opinion upon which to guide clinical practice. Expert opinion draws upon certain individual’s large clinical experience, resulting in a select group of experts impacting care. Hernia registries are a robust source of information from a broad range of surgeons performing various techniques. This variety allows for a practical approach to answering clinical questions. The cumulative experience of all surgeons is greater than that of any individual.The most notable are the Danish and Swedish hernia registries, whose strength is rooted in their national healthcare system with surgeon-independent, bias-free outcome tracking. Other notable national and multinational registries are Germany’s Herniamed registry and the European Hernia Registry (EuraHS). We are proud to announce the Americas Hernia Society Quality Collaborative registry recently added an inguinal module to our existing ventral module, with which we have been able to address real world clinical dilemmas. Although randomized clinical trials remain integral to the scientific method, interpretation of their results are limited to the study population and controlled variables which are restrictive compared to the daily scenarios facing surgeons. With the collaborative, crowd-sourced data provided by large hernia registries, surgeons around the world will finally be able to determine the optimal management of groin hernias, but first, we must all participate.
Alfredo M Carbonell, President AHS
Compliance with ethical standards
Conflict of interest
Alfredo M. Carbonell has received a speaker honorarium from Intuitive Surgical.