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Endorsement of the Herniasurge guidelines by the European Hernia Society

Article in Hernia · January 2018

DOI: 10.1007/s10029-017-1678-8

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Giampiero Campanelli
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Endorsement of the Herniasurge guidelines
by the European Hernia Society

G. Campanelli

Hernia
The World Journal of Hernia and
Abdominal Wall Surgery

ISSN 1265-4906
Volume 22
Number 1

Hernia (2018) 22:169

DOI 10.1007/s10029-017-1678-8

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 Author's personal copy
Hernia (2018) 22:169
https://doi.org/10.1007/s10029-017-1678-8
INVITED COMMENTARY
Endorsement of the Herniasurge guidelines by the European
Hernia Society
G. Campanelli1
Received: 13 July 2017 / Accepted: 20 September 2017 / Published online: 12 January 2018
© Springer-Verlag France SAS 2017
Inguinal hernia is one of the most common surgical dis-
eases in the world and approximately 20 million procedures
are required each year for its treatment. A mesh is used for
reinforcement in most patients, making a large-scale world-
wide market for these devices. The competition between
companies is high, resulting in a huge number of options
of different meshes and devices to be used. Evaluation of
performance and in what situations to use these different
devices has become so complicated that hernia surgery has
almost become a “super-specialty” of its own.
To give the majority of general surgeons evidence-based
guidance in their daily practice for inguinal hernia surgery, the
European Hernia Society (EHS), that I have the privilege to
be the current president of, published the EHS Guidelines in
Hernia in 2009. It has been the most downloaded (from Her-
nia Springer Journal) recommendations in the recent years.
To update this work, a group of “experts” including indi-
viduals from across the globe with the participation of young
researchers interested in this topic, the Herniasurge group,
has further refined the EHS guidelines into these Interna-
tional Guidelines, now endorsed by six other international
societies. The result of this massive effort can be enjoyed by
general and specialized hernia surgeons around the world. It
provides a useful guide in daily practice and can be used to
confirm or to give education on/or evidence for techniques
or meshes to be used by the individual surgeon.
It is important to emphasize that the guidelines are to be
used as a support on how to make your own algorithm for
This comment refers to the article available at doi:10.1007/
s10029-017-1668-x.
* G. Campanelli
giampiero.campanelli@grupposandonato.it
1
University of Insubria, Istituto Clinico Sant’Ambrogio -
Milano Hernia Center, Milan, Italy
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therapy. They should be viewed as “suggestions” rather than
“Gospel” that must be followed religiously; in fact guidelines
should be considered only supportive of the knowledge that
inevitably must be considered from the perspective of the per-
sonal experience and “common sense” of the hernia surgeon.
A strength of these guidelines is that they not only take
into account different meshes/devices and open and laparo/
endoscopic approaches, but also the perspective of hernia
surgery in low income countries. They give valid guid-
ance for education and safe techniques to be used (mainly
the Lichtenstein technique). For each of these options, the
guidelines analyze different variables like cost, complica-
tions, technical aspects, outcome, etc.
Considering the entire planet, the vast majority of countries
do have very limited resources for hernia surgery. The surgi-
cal approach differs and a pure tissue repair might be the only
option. Hernia missions have been initiated forming several
projects around the globe for guidance and local education
in line with the new guidelines adapted for local conditions.
Finally, I feel (and this is my surgical daily practice)”hernia
surgery of today” must endorse a tailored approach to be used
in terms of the patients wishes, his/her own needs, expectations,
and in terms of other characteristics/conditions: risk factors,
anatomy, surgeon availability and competence, and other surgi-
cal conditions. These guidelines will be a precious instrument
in the “armamentarium” of surgeons in order for them to under-
stand the anatomy, up to date knowledge of surgical procedures,
and their own local limitations of resources, thus realizing this
tailoring to give to patients the best opportunity for healing.
Prof. Giampiero Campanelli, President EHS.
Compliance with ethical standards
Conflict of interest The author declares that he has no conflict of
interest.
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