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Herniasurge – what happened to it? No updates, no contact points
When the “International Guidelines for Groin Hernia Management” were introduced in 2018, even though they seemed biased and flawed, at least they said that they had plans to review and update the Guidelines on a regular basis. Many of the recommendations had the warning that the research was poor and more was needed, but it was the best that they could do at the time.
But the updates do not seem to have occurred and the Herniasurge group has been inactive for years. They seem to have gone dormant. The web site is dead even though it is still shown in the document as the place to go to get clarification and supporting data. It makes you wonder if the people involved in putting the whole thing together really still believe in what they did.
If it truly has value surely it is worth maintaining. Who is running the show now? Dr. Ramshaw has moved on, who is left?
Here is the latest version of the “Guidelines” available from Google Scholar, published January 2018, and an excerpt.
https://link.springer.com/article/10.1007/s10029-017-1668-x
“The HerniaSurge Group has formulated a large number of new research questions. The guidelines will be updated every 2 years as new evidence is published. The expiration date for this document is June 1, 2018.
The guidelines were externally reviewed by professors Jeekel (Europe), Ramshaw (USA) and Sharma (Asia). The Agree scores are published in the website of HerniaSurge (https://www.herniasurge.com).”
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32 Replies
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Another month has passed and still not a peep from any of the societies, groups, collaborations, or individual members about the flawed and incomplete “Guidelines”. Incredibly unprofessional from an organization, the EHS, that has tried to assume the mantle of the ultimate global authority on groin hernia management. They are leaving all of their members and associated societies in the dark about what the specific deficiencies are in the ten chapters that are being “updated”.
This could end up being a good thing though. Independent surgeons should be questioning the veracity of the whole “Guidelines” enterprise. If it is not good enough to follow through on, then is it worth anything at all. What is it? It has not been updated on the two year basis that was promised. They have identified ten chapters that need work. They promised an update, specifically, on LinkedIn, almost a year ago. Yet, nothing at all has happened.
Still, esteemed professionals like Dr. Chen refer to the Guidelines in their presentations and publications. It’s a travesty. The law firms should be looking at the people behind the recommendations for the materials that are being referred to in the lawsuits. The device suppliers support the societies with funds, the societies create the recommendations to use their devices, the device makers make more money. It’s all out in the open, documented.
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We’re a week in to September, 2/3 of the way through the year, and still not a peep about the update to the Guidelines. I wonder if the people involved have become aware of their liabilities in promoting this document. The mesh lawsuits that looked like they were about to have a global settlement, so that business could continue as usual, have been delayed and a similar single mesh lawsuit had a huge settlement, in the millions of dollars. It would be awkward to promote the use of a product with 100’s of millions or billions of dollars worth of legal costs associated to it. And there’s no reason to expect the constant stream of new lawsuits to diminish. The products and procedures are essentially the same.
It’s unclear what the real reason is for the delay. Silence after exuberance usually comes from a realization that things aren’t as they seemed.
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Still no word at all from EHS/HerniaSurge. Ten chapters being updated in the “International guidelines for groin hernia management”. The group said their work was almost done at the end of 2022. What could be causing the delay?
They should at least tell which ten chapters are outdated. It makes a person wonder about the professionalism of this huge organization. They have roped in many other national hernia repair societies and now they are all left hanging. How can any patient be confident in their surgeon if they say that they are following the Guidelines, which have been defined as outdated?
https://europeanherniasociety.eu/guidelines/international-guidelines-for-groin-hernia-management-2/
“…
The guidelines were developed by The HerniaSurge Group and have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. The guidelines were published in 2018 in the Journal Hernia. Ten chapters are in the process of being updated.
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We are seven months through 2023, over halfway through the year, and still no word from the EHS or the HerniaSurge people about the delay in the new Groin Hernia Guidelines. Maybe they’ve realized that the title should be “Guidelines for mesh repair of groin hernias”. They are on the wrong side of the trend now. Fighting the tide.
“this year!” on the LinkedIn page was last year. 2022.
Also just noticed that if you scroll down the EHS Guidelines page linked in the post above the three “Platinum” sponsors of the EHS pop up at the bottom. Mesh, mesh, and robotic surgery (also mesh by default).
PLATINUM CORPORATE ALLIANCE OF THE EHS
BD, Medtronics, and Intuitive. -
I miswrote in my post above, I was a month early. Now, today, it has been 6 months past the promised update time. The year is half gone.
The EHS has changed their main web page and I found that they do refer to updates as being in progress but do not give an expected date of publication. Considering all it would be surprising if they made any firm statements suggesting that mesh of any type is not the first recommendation for repair of any hernia type. Maybe they will release something before 2024 gets here.
Ten chapters is kind of specific. What could the holdup be?
https://europeanherniasociety.eu/international-guidelines-for-groin-hernia-management-2/
“…
The guidelines were developed by The HerniaSurge Group and have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. The guidelines were published in 2018 in the Journal Hernia. Ten chapters are in the process of being updated.Reference: HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165. doi: 10.1007/s10029-017-1668-x. Epub 2018 Jan 12. PMID: 29330835; PMCID: PMC5809582.
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Here is a cross-post to a recent interview with Dr. Lorenz, one of the newer HerniaSurge members.
https://herniatalk.com/forums/topic/dr-ralph-lorenz-hernia-talk-6th-june/#post-35821
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Six months, 1/2 year, past the committed-to deadline and still not a word about the update or the delay. Five years since the original commitment of update every two years.
It’s really looking like there’s either conflict behind the scenes or that they are just going to pretend that the commitment was never made. It must be disappointing, and embarrassing, to be a part of the whole fiasco.
The law firms certainly must be aware of the Guidelines, and should be aware of these statements about updating them to keep them current. If I was a law firm I would dig in to what is happening with this group, which now seems to be called the Herniasurge Collaboration. The whole foundation of the Guidelines was built on it being supported by a professional organization, with a contact point, and known members, with regular updates to the Guidelines. All of that has changed, in strange ways, with regular names changes and dead web sites and Facebook pages, and the commitments have not been kept.
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This is a replay for William from Oceanic’s Topic.
I think that many surgeons got roped in to the Guidelines effort without realizing what was actually happening. It seemed like a good idea to create a baseline of methods, at least to use for future reference. But the failure to follow-up on the promises to update the document, and the constant and growing problem with mesh-related pain, has probably made many of them question their association with the document. Dr. Campanelli and Dr. Conze are not shown as members of the new Collaboration group.
The Collaboration and some or all of the members were shown in a recent publication about the fairly new Scrotal Inguinal Hernia guidelines. Post #34383 in my other thread. The Journal of Abdominal Wall Surgery (JAWS, ha ha ha) is the official publication of the European Hernia Society. You can see how powerful the EHS is getting.
https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11195/full
Here is the list of members at that time, apparently. Notice that they still talk about HerniaSurge as an existing authoritative entity but only suggest contacting authors of individual segments directly if there are questions.
HerniaSurge Collaboration
F. Agresta, F. Berrevoet, I. Burgmans, D. C. Chen (AHS), A. de Beaux, B. East, N. Henriksen, F. Köckerling, M. Lopez-Cano, R. Lorenz, M. Miserez, A. Montgomery, S. Morales-Conde, C. Oppong, M. Pawlak, M. Podda, D. Sanders, A. Sartori, M.P. Simons (former EHS secretary for quality), C. Stabilini (EHS secretary for Science), H. M. Tran (Australasian Hernia Society), N. van Veenendaal, M. Verdauguer, R. Wiessner.Herniasurge – what happened to it? No updates, no contact points
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Here are the three Guidelines links, 2009, 2014, and 2018.
https://link.springer.com/article/10.1007/s10029-009-0529-7
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I’ve been curious, actually fascinated, about how the massively influential “International guidelines for groin hernia management” got produced so have been collecting the documents about its development. The original document was produced by the European Hernia Society in 2009 and listed all of the authors. It was updated in 2014, again with all of the authors listed. In 2018 they created a new group that they called the “HerniaSurge” group, and described making supporting data available and ways to contact the group if there were questions. Since then the Group has gone almost completely dark, only appearing as buried references in various documents, under a changed name, the “HerniaSurge Collaboration”. I posted about this collaboration earlier in this thread. The web site link for the Group is dead. Their Facebook page has only a few posts. Basically all of the foundational work for the Guidelines is inaccessible. The document exists as gospel, referenced with confidence by surgeons around the world, but they don’t realize that it is now an empty shell and that the original authors seem to be second-guessing their work on it.
2018 was really not that long ago. Since then Dr. Campanelli has written several editorials in Hernia journal about the chronic pain from hernia repair problem, first proclaiming that the problem was real and describing a future collection and special issue about the problem. But then finishing the project with an Editorial that suggested that the problem was not real, and that it had arisen because people expected too much from life.
https://link.springer.com/article/10.1007/s10029-017-1668-x
Published: 12 January 2018
International guidelines for groin hernia management
The HerniaSurge Group
Hernia volume 22, pages1–165 (2018)Here is one of 80 references to the HerniaSurge group, with a dead link to a web site –
“All search strategies, tables with articles and background information will be published on HerniaSurge’s website (https://www.herniasurge.com). All articles are filed per chapter in MendeleyR reference manager.
We would like to emphasize the fact that the “International Guidelines for Groin Hernia Management” is NOT a legal document, merely guidelines. If surgeons choose not to follow strong recommendations, they should do so in consultation with their patients and document this in the medical record. …”
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Four months in to 2023 and still no sign of updated Guidelines. And the link to the newsletter does not work anymore.
EHS seems to have revised their web site. Some material that you’d think would be free is members only.
https://europeanherniasociety.eu/do-mesh-devices-make-hernia-repair-easier/
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Here is the last notice about the updated guidelines. From the EHS newsletter of October 2022. The prior newsletters seemed to be about every 3-4 months. They are way behind.
https://www.europeanherniasociety.eu/ehsnewsletter18
And here is what appears to be the official EHS publication, according to the newsletter. I would expect the updates to be published here, possibly. The scrotal inguinal hernia guidelines are.
https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery
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I just realized that even the EHS has a piece of mesh as part of their logo. Basically they are flying a mesh flag. It is really very strange. It’s almost like worship.
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Here is a short reminder/summary of where my cynicism and skepticism come from. Dr. Towfigh provided the LinkedIn link above, recopied below, that showed that HerniaSurge is an extension of the efforts of the European Hernia Society (EHS). Supposedly they were almost finished with the updates to the 2018 Hernia Repair Guidelines, which were originally supposed to be updated every two years. So far there are no updates, only a new subset of Guidelines for scrotal inguinal hernias.
We are now three months past the promised date. There is no sign that some significant event has occurred that would cause a delay. What is going on? I see now that they only promised “recommendations”, with a publication of some sort. Where is it? Who decides on whether or not to update the Guidelines with the recommendations? Even if there is no change there should be a communication about the results.
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The name HerniaSurge has made a new appearance. It’s been modified again, it’s now HerniaSurge Collaboration. Dr. Maarten Simons is the representative. At the end of the article the full HerniaSurge Collaboration list of members is shown. Still odd in how mysterious the group is. Who pays for their efforts?
Apparently the Collaboration has identified a specific sub-category of hernia and determined that it needs specific guidelines. The study follows the same general format as the original guidelines. It’s interesting to see how almost all of the levels of evidence are low and the recommendations are weak (by their definitions). In other words, of little real value except to show that nobody knows what’s best.
The Collaboration seems to be generally defining the world in terms of low resource and high resource. In other words, poor and rich.
The original 2018 Guidelines remain unchanged, despite promises of updates. But it is still the first reference in this paper.
https://linktr.ee/EHSguidelines
https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11195/full
ORIGINAL RESEARCH
J. Abdom. Wall Surg., 27 March 2023
https://doi.org/10.3389/jaws.2023.11195
Systematic Review and Guidelines for Management of Scrotal Inguinal Hernias
Hanh Minh Tran1*, Ian MacQueen, David Chen, Maarten Simons on behalf of HerniaSurge Collaboration“…In high resource settings, an open anterior repair is the default operation. The Lichtenstein operation is still considered the gold standard for anterior open repair (1). The endoscopic hernia repair methods have been shown to be safe and effective with acceptable low complication rates in specialized centers (5, 15, 17, 20). There is a high conversion rate when starting with an endo-laparoscopic technique, especially TEP. Low resource countries may not be able to afford the mesh and/or consider their operative settings to be sufficient for sterile standards to prevent mesh infection and its sequelae. Therefore, suture repair still remains a standard option in these settings. Teaching and training to master the Shouldice technique remains an important cornerstone for surgical management of inguinal hernias in low resource settings. …
HerniaSurge Collaboration
F. Agresta, F. Berrevoet, I. Burgmans, D. C. Chen (AHS), A. de Beaux, B. East, N. Henriksen, F. Köckerling, M. Lopez-Cano, R. Lorenz, M. Miserez, A. Montgomery, S. Morales-Conde, C. Oppong, M. Pawlak, M. Podda, D. Sanders, A. Sartori, M.P. Simons (former EHS secretary for quality), C. Stabilini (EHS secretary for Science), H. M. Tran (Australasian Hernia Society), N. van Veenendaal, M. Verdauguer, R. Wiessner.” -
Two and a half months in to 2023 and no mention at all of the updated inguinal hernia repair guidelines. It really looks like they are going to pretend that no commitments were made. If they believe that the current Guidelines are sufficient then ethics and professionalism suggest that they should just say so. Why are they hiding? Dr. Towfigh believed in them. That must be a disappointment.
This is from their LinkedIn page –
“European Hernia Society
European Hernia SocietyEuropean Hernia Society
2,088 followers2,088 followers
7mo • 7 months agoFollow
HerniaSurge #InguinalHernia updates guidelines team discussing recommendations. Publication this year!”
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Very strange that the European Hernia Society would promote a link from their Facebook page directly to the guidelines page. Even though they are coming up on three months behind schedule for the updated Inguinal Hernia Guidelines they promised in 2022.
This is from one day ago.
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The EHS Facebook page is up to date. They have a notice about the new Hernia issue on chronic pain. Apparently they just had a board meeting two days ago. They had to have discussed the delay in the new Guidelines. Nothing wrong with delaying if they are attempting to get things right but they really should be providing updates. And there should be a note on the current web page that the Guidelines are out of date and new ones are coming.
It’s a good place to catch links to new papers about hernia surgery.
https://www.facebook.com/people/European-Hernia-Society/100070922043834/
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Coming up on a month and half past the end of 2022 and still no updated hernia repair guidelines. All of the HerniaSurge links are still dead.
The last update was for abdominal wall incisions, in August of 2022.
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Another interesting paper that mentions “HerniaSurge” even though the group does not seem to exist anymore.
Also interesting in that they refer to their work as assisting in the update of the Guidelines, but note that the recurrence rates for hernia repair are still very high. The whole premise of laparoscopic mesh repair is that recurrence rates are lower. References 4-7 are all from 2018 – 2020.
It wouldn’t be a surprise if EHS or the “HerniaSurge” group have found themselves in a bind, where the review of new data shows that the 2018 Guidelines are seriously flawed. The delay and lack of communication is telling.
“The routine use of mesh in groin hernia surgery has engendered substantially decreased recurrence risk.1,2 However, current long-term reoperation rates for recurrence are still disappointing, in the range of 8% to 15%.3-7”
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