Unit of Wall Surgery

  • Francesco GossettiEmail author
  • Linda D’Amore
  • Francesca Ceci
  • Lucia Bambi
  • Elena Annesi
  • Paolo Negro


The increasing number of abdominal wall repairs (AWR) for primary and incisional hernias performed yearly worldwide, the complication and recurrence rate of this surgery, with the attention focusing on high risk patient, the new reconstructive procedures, and the introduction on the market of numerous meshes and devices make inevitable that surgeons specialize in abdominal wall surgery. This is particularly true in case of complex AWR (cAWR), where surgeon’s volume experience has been demonstrated to play a significant role in the outcome. In addition, the management of these patients may result in high financial losses no more sustainable by the institutions. Therefore, it is necessary to implement more cost-efficient strategies to correct the balance. This objective can be more easily achieved in facilities specifically dedicated to the treatment of hernias.

Actually there is an increasing number of such hernia centers, both hospital-affiliated and independent, but at the moment an exact definition of their characteristics is lacking, except in Germany. A clear certification program of the experience of both surgeons and facilities is needed everywhere, based on precise parameters, following the principles of safety of the patient, good practice, and sustainable costs.

Recently the Italian Society of Hernia and Abdominal Wall Surgery (ISHAWS) has proposed a certification program for both surgeons and facilities, based on parameters derived from an accurate review of the literature.


Hernia center Groin hernia Incisional hernia Abdominal wall repair Outcomes Cost Complications 


  1. 1.
    Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012;16:179–83.CrossRefGoogle Scholar
  2. 2.
    Roll A. A global vision for hernia repair improvement. Gen Surg Laparosc News. 2012;39:1.Google Scholar
  3. 3.
    Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repairs improved with times? A population-based analysis. Ann Surg. 2003;237:129–35.CrossRefGoogle Scholar
  4. 4.
    Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, Kercher KW, Lammers BJ, Parra-Davilla E, Roll S, Towfigh S, van Geffen E, Conze J, van Goor H. Criteria for definition of a complex abdominal wall hernia. Hernia. 2014;18:7–17.Google Scholar
  5. 5.
    Fischer JP, Wes AM, Wink JD, Nelson JA, Rohrbach JI, Braslow BM, Kovasch SJ. Analysis of perioperative factors associated with increased cost following abdominal wall reconstruction (AWR). Hernia. 2014;18:617–24.CrossRefGoogle Scholar
  6. 6.
    Sanders DL, Kingsnorth AN, Windsor AC. Is there a role for hernia subspecialist? Or is this a step too far? Hernia. 2016;20:637–40.CrossRefGoogle Scholar
  7. 7.
    Berry MF, Paisley F, Low DW, Rosato EF. Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy. Am J Surg. 2007;194:199–204.CrossRefGoogle Scholar
  8. 8.
    Gossetti F, D’Amore L, Ceci F, Grimaldi MR, Negro P. Abdominal wall reconstruction (AWR): The need to identify the hospital units and referral centers entitled to perform it. Updat Surg. 2017;69:289–90. Scholar
  9. 9.
    Aquina CT, Kelly KN, Probst CP, Iannuzzi JC, Noyes K, Langstein HN, Monson JR, Fleming FJ. Surgeon volume plays a significant role in outcomes and cost following open incisional hernia repair. J Gastrointest Surg. 2015;19:100–10. Scholar
  10. 10.
    Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. New Engl J Med. 1979;301:1364–9.CrossRefGoogle Scholar
  11. 11.
    Kalacoglu H, Oztuna D. Current status of hernia centres around the globe. Indian J Surg. 2015;77(Suppl 3):S1023–6. Scholar
  12. 12.
    Poulose BK, Roll S, Murphy JW, Mattews BD, Todd Heniford B, Voeller G, Hope WW, Goldblatt MI, Adrales GL, Rosen MJ. Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia. 2016;20:177–89. Scholar
  13. 13.
    Kockerling F, Berger D, Jost JO. What is a certified hernia center? The example of the German Hernia Society and German Society of General and Visceral Surgery. Front Surg. 2014;1:1–4. Scholar
  14. 14.
    Lorenz R, Stechemesser B, Reinpold W, Fortenly R, Mayer F, Schroeder W, Kockerling F. Development of a standardized curriculum concept for continuing training in hernia surgery: German Hernia School. Hernia. 2017;21:153–62. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Francesco Gossetti
    • 1
    Email author
  • Linda D’Amore
    • 1
  • Francesca Ceci
    • 1
  • Lucia Bambi
    • 2
  • Elena Annesi
    • 2
  • Paolo Negro
    • 1
  1. 1.Department of Surgery, Abdominal Wall Surgery UnitSapienza University of RomeRomeItaly
  2. 2.Graduate School in General SurgerySapienza University of RomeRomeItaly

Personalised recommendations