Advertisement

Establishing a Hernia Program

  • Karla Bernardi
  • Mike K. LiangEmail author
Chapter

Abstract

Abdominal wall and groin hernias are among the most common pathologies seen by clinicians. The prevalence of these hernias is on the rise due to their strong relationship to patient comorbidities such as smoking and obesity. Patients with comorbidities are not only more likely to develop a hernia, but they are also more likely to suffer a major complication whether their hernia is treated (e.g., hernia recurrence) or not (e.g., incarceration). In addition, after each failed repair, a successful subsequent repair is less and less likely.

Because of this, there has been interest in regionalization of care for patients with comorbidities or complex hernias. Specialized hernia programs aim to improve outcomes, control cost, and promote research. This chapter will review the evidence behind and provide a guide to development of a Hernia Center of Excellence. In addition, evidence for and guide to long-term follow-up of patients with hernias will be discussed.

Keywords

Hernia program Center of Excellence Guidelines Standards Recommendations Expectations Follow-up 

References

  1. 1.
  2. 2.
    Köckerling F, et al. What is a certified hernia center? The example of the German Hernia Society and German Society of General and Visceral Surgery. Front Surg. 2014;1:26.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Liang MK, et al. Ventral hernia management: expert consensus guided by systematic review. Ann Surg. 2017;265(1):80–9.CrossRefGoogle Scholar
  4. 4.
    Holihan JL, et al. Ventral hernia: patient selection, treatment, and management. Curr Probl Surg. 2016;53(7):307–54.CrossRefGoogle Scholar
  5. 5.
    Miserez M, et al. The European Hernia Society groin hernia classification: simple and easy to remember. Hernia. 2007;11(2):113–6.CrossRefGoogle Scholar
  6. 6.
    Miserez M, et al. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18(2):151–63.CrossRefGoogle Scholar
  7. 7.
    Muysoms FE, et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407–14.CrossRefGoogle Scholar
  8. 8.
    Śmietański M, et al. European Hernia Society classification of parastomal hernias. Hernia. 2014;18(1):1–6.CrossRefGoogle Scholar
  9. 9.
    Poulose BK, et al. Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia. 2016;20(2):177–89.CrossRefGoogle Scholar
  10. 10.
    Muysoms FE, et al. Recommendations for reporting outcome results in abdominal wall repair: results of a consensus meeting in Palermo, Italy, 28–30 June 2012. Hernia. 2013;17(4):423–33.CrossRefGoogle Scholar
  11. 11.
    Holihan JL, et al. Adverse events after ventral hernia repair: the vicious cycle of complications. J Am Coll Surg. 2015;221(2):478–85.CrossRefGoogle Scholar
  12. 12.
    Holihan JL, et al. Use of computed tomography in diagnosing ventral hernia recurrence: a blinded, prospective, multispecialty evaluation. JAMA Surg. 2016;151(1):7–13.CrossRefGoogle Scholar
  13. 13.
    Helgstrand F, et al. Reoperation versus clinical recurrence rate after ventral hernia repair. Ann Surg. 2012;256(6):955–8.CrossRefGoogle Scholar
  14. 14.
    Simons MP, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.CrossRefGoogle Scholar
  15. 15.
    Poelman MM, et al. EAES consensus development conference on endoscopic repair of groin hernias. Surg Endosc. 2013;27(10):3505–19.CrossRefGoogle Scholar
  16. 16.
    Cuccurullo D, et al. Laparoscopic ventral incisional hernia repair: evidence-based guidelines of the first Italian Consensus Conference. Hernia. 2013;17:557–66.CrossRefGoogle Scholar
  17. 17.
    Silecchia G, et al. Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference. Surg Endosc. 2015;29:2463–84.CrossRefGoogle Scholar
  18. 18.
  19. 19.
    Holihan JL, et al. Ventral hernia repair: a meta-analysis of randomized controlled trials. Surg Infect (Larchmt). 2017;18(6):647–58.CrossRefGoogle Scholar
  20. 20.
  21. 21.
    Woolf SH, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527–30.CrossRefGoogle Scholar
  22. 22.
    Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342(8883):1317–22.CrossRefGoogle Scholar
  23. 23.
    Berger D. Evidence-based hernia treatment in adults. Dtsch Arztebl Int. 2016;113(9):150–7.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Hargreaves JA. Do clinical guidelines for hernia surgery reduce costs and improve patient outcomes, and do surgeons follow them? Value Health. 2015;18(7):A570–1.CrossRefGoogle Scholar
  25. 25.
    Ioannidis JP. Why most published research findings are false. PLoS Med. 2005;2(8):e124.CrossRefGoogle Scholar
  26. 26.
    Holihan JL, et al. A systematic review of randomized controlled trials and reviews in the management of ventral hernias. J Surg Res. 2016;204(2):311–8.CrossRefGoogle Scholar
  27. 27.
    Olavarria OA, et al. Comparison of conflicts of interest among published hernia researchers self-reported with the Centers for Medicare and Medicaid Services Open Payments Database. J Am Coll Surg. 2017;224(5):800–4.CrossRefGoogle Scholar
  28. 28.
  29. 29.
    Zwaans WAR, et al. Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults (Protocol). Cochrane Database Syst Rev. 2017;(4):CD012630.Google Scholar
  30. 30.
    Verhagen T, et al. The GroinPain trial: a randomized controlled trial of injection therapy versus neurectomy for postherniorrhaphy inguinal neuralgia. Ann Surg. 2017;267(5):841–5.CrossRefGoogle Scholar
  31. 31.
    Cherla DV, et al. Decreasing surgical site infections after ventral hernia repair: a quality-improvement initiative. Surg Infect (Larchmt). 2017;18(7):780–6. PMID: 28832246.CrossRefGoogle Scholar
  32. 32.
    Tandon A, et al. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg. 2016;103:1598–607.CrossRefGoogle Scholar
  33. 33.
    Holihan JL, et al. Component separation vs. bridged repair for large ventral hernias: a multi-institutional risk-adjusted comparison, systematic review, and meta-analysis. Surg Infect (Larchmt). 2016;17(1):17–26.CrossRefGoogle Scholar
  34. 34.
  35. 35.
    Feldman LS, et al. The SAGES/ERAS® society manual of enhanced recovery programs for gastrointestinal surgery. New York: Springer; 2015.CrossRefGoogle Scholar
  36. 36.
    Jensen KK. Recovery after abdominal wall reconstruction. Dan Med J. 2017;64(3). pii: B5349.Google Scholar
  37. 37.
    Law LS, et al. Paravertebral block for inguinal herniorrhaphy: a systematic review and meta-analysis of randomized controlled trials. Anesth Analg. 2015;121(2):556–69.CrossRefGoogle Scholar
  38. 38.
    Gao T, et al. Evaluation of transversus abdominis plane (TAP) block in hernia surgery: a meta-analysis. Clin J Pain. 2017;33(4):369–75.CrossRefGoogle Scholar
  39. 39.
    Köckerling F, et al. The importance of registries in the Postmarketing surveillance of surgical meshes. Ann Surg. 2017. PMID: 28594740.Google Scholar
  40. 40.
    Osborne NH, et al. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA. 2015;313(5):496–504.CrossRefGoogle Scholar
  41. 41.
    Nijjar SK, et al. Participation in clinical trials improves outcomes in women’s health: a systematic review and meta-analysis. BJOG. 2017;124(6):863–71.CrossRefGoogle Scholar
  42. 42.
    Elrod JK, Fortenberry JL Jr. Centers of excellence in healthcare institutions: what they are and how to assemble them. BMC Health Serv Res. 2017;17(Suppl 1):425.CrossRefGoogle Scholar
  43. 43.
    Morche J, et al. Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst Rev. 2016;5(1):204.CrossRefGoogle Scholar
  44. 44.
    Köckerling F, et al. Does surgeon volume matter in the outcome of endoscopic inguinal hernia repair? Surg Endosc. 2017;31(2):573–85.CrossRefGoogle Scholar
  45. 45.
    Helgstrand F. National results after ventral hernia repair. Dan Med J. 2016;63(7). pii: B5258.Google Scholar
  46. 46.
    Raigani S, et al. The impact of developing a comprehensive hernia center on the referral patterns and complexity of hernia care. Hernia. 2014;18(5):625–30.CrossRefGoogle Scholar
  47. 47.
    Cox TC, et al. The cost of preventable comorbidities on wound complications in open ventral hernia repair. J Surg Res. 2016;206(1):214–22.CrossRefGoogle Scholar
  48. 48.
    Martindale RG, Deveney CW. Preoperative risk reduction: strategies to optimize outcomes. Surg Clin North Am. 2013;93(5):1041–55.CrossRefGoogle Scholar
  49. 49.
    O’Neill S, et al. A national trainee-led audit of inguinal hernia repair in Scotland. Hernia. 2015;19(5):747–53.CrossRefGoogle Scholar
  50. 50.
    Research, Committee on Conflict of Interest in Medical, et al. Conflict of interest in medical research, education, and practice. Washington, DC: National Academies Press; 2009.Google Scholar
  51. 51.
    https://www.cms.gov/openpayments/. Accessed 30 Aug 2017.
  52. 52.
    Holihan JL, et al. How long is long enough to identify a surgical site infection? Surg Infect (Larchmt). 2017;18(4):419–23.CrossRefGoogle Scholar
  53. 53.
    Mizrahi H, Parker MC. Management of asymptomatic inguinal hernia: a systematic review of the evidence. Arch Surg. 2012;147(3):277–81.CrossRefGoogle Scholar
  54. 54.
    Fitzgibbons RJ Jr, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006;295(3):285–92.CrossRefGoogle Scholar
  55. 55.
    de Goede B, et al.; INCA Trialists’ Collaboration. Watchful waiting versus surgery of mildly symptomatic or asymptomatic inguinal hernia in men aged 50 years and older: a randomized controlled trial. Ann Surg. 2017;267(1):42–9.Google Scholar
  56. 56.
    Holihan JL, et al. A prospective assessment of clinical and patient-reported outcomes of initial non-operative management of ventral hernias. World J Surg. 2017;41(5):1267–73.CrossRefGoogle Scholar
  57. 57.
    Burgmans JP, et al. Long-term results of a randomized double-blinded prospective trial of a lightweight (Ultrapro) versus a heavyweight mesh (Prolene) in laparoscopic Total Extraperitoneal inguinal hernia repair (TULP-trial). Ann Surg. 2016;263(5):862–6.CrossRefGoogle Scholar
  58. 58.
    Demetrashvili Z, et al. Open retromuscular mesh repair versus onlay technique of incisional hernia: a randomized controlled trial. Int J Surg. 2017;37:65–70.CrossRefGoogle Scholar
  59. 59.
    Garvey PB, et al. Long-term outcomes after abdominal wall reconstruction with acellular dermal matrix. J Am Coll Surg. 2017;224(3):341–50.CrossRefGoogle Scholar
  60. 60.
    Löfgren J, et al. A randomized trial of low-cost mesh in groin hernia repair. N Engl J Med. 2016;374(2):146–53.CrossRefGoogle Scholar
  61. 61.
    Luijendijk RW, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.CrossRefGoogle Scholar
  62. 62.
    Burger JW, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–83.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Nikkolo C, et al. Three-year results of a randomized study comparing self-gripping mesh with sutured mesh in open inguinal hernia repair. J Surg Res. 2017;209:139–44.CrossRefGoogle Scholar
  64. 64.
    Rönkä K, et al. A single-surgeon randomized trial comparing three meshes in lichtenstein hernia repair: 2- and 5-year outcome of recurrences and chronic pain. Int J Surg. 2013;11(1):81–4.CrossRefGoogle Scholar
  65. 65.
    Rosen MJ, et al. Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Ann Surg. 2017;265(1):205–11.CrossRefGoogle Scholar
  66. 66.
    Zwaans WAR, et al. Groin pain characteristics and recurrence rates: three-year results of a randomized controlled trial comparing self-gripping Progrip mesh and sutured polypropylene mesh for open inguinal hernia repair. Ann Surg. 2017;267(6):1028–33.CrossRefGoogle Scholar
  67. 67.
    Kokotovic D, et al. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA. 2016;316(15):1575–82.CrossRefGoogle Scholar
  68. 68.
    van Ramshorst GH, et al. A comparative assessment of surgeons’ tracking methods for surgical site infections. Surg Infect (Larchmt). 2013;14(2):181–7.CrossRefGoogle Scholar
  69. 69.
    Petherick ES, et al. Methods for identifying surgical wound infection after discharge from hospital: a systematic review. BMC Infect Dis. 2006;6:170.CrossRefGoogle Scholar
  70. 70.
    de Oliveira AC, Carvalho DV. Evaluation of underreported surgical site infection evidenced by post-discharge surveillance. Rev Lat Am Enfermagem. 2007;15(5):992–7.CrossRefGoogle Scholar
  71. 71.
    Henchcliffe BE, et al. Barriers to participation in preoperative risk-reduction programs prior to ventral hernia repair: an assessment of underserved patients at a safety-net hospital. JAMA Surg. 2016;151(5):488–90.CrossRefGoogle Scholar
  72. 72.
    Alawadi ZM, et al. Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: a provider and patient perspective. Surgery. 2016;159(3):700–12.CrossRefGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2019

Authors and Affiliations

  1. 1.Department of General SurgeryMcGovern Medical School, University of Texas Health Science CenterHoustonUSA

Personalised recommendations