Herniasurge – what happened to it? No updates, no contact points

Hernia Discussion Forums Hernia Discussion Herniasurge – what happened to it? No updates, no contact points


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    • #32634
      Good intentions

      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.


      “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).”

    • #32639
      Good intentions

      Here’s the Facebook page. https://www.facebook.com/herniasurge/

    • #32660

      HerniaSurge is an impromptu group of experts led by the European surgeons. They are working in their next updated guidelines.

      Read more about that here: https://www.linkedin.com/posts/european-hernia-society_inguinalhernia-euroherniasnews-herniaguidelines-activity-6970116740076732416-3hGD?utm_source=share&utm_medium=member_ios

      Should have their publications by the end of this year.

    • #32666
      Good intentions

      Thanks for the reply Dr. Towfigh. There is really nothing substantial to read in that single month old LinkedIn posting, but it is something, at least.

      My understanding is that Herniasurge is just a formalization of a combined effort, based on past efforts by several organizations. The same group that put together the 2009 European Hernia Society guidelines was involved. The same names plus some new ones. So, not really “impromptu”. Looks like a pretty long-term plan.

      It will be interesting to see what they come up with. Especially after Dr. Campanelli’s Editorial about how “chronic pain is real” and that there will be a focus on it this year. Strange though that the Herniasurge web site is dead, and the Facebook page inactive, but somebody found the time to post on EHS’s Linkedin page.

      Here is a good summary of the efforts that resulted in the Herniasurge Guidelines. And a link to the EHS guidelines of 2009.



    • #32667
      Good intentions

      Dr. Lorenz was in the LinkedIn picture and he posted soon after the Guidelines were published about one of the deficiencies of the Guidelines. It will be interesting to see if they take the obvious step, as Dr. Towfigh noted in her recent presentation, of recommending more pure tissue repairs. It’s hard to see how they could avoid it.


      Excerpt –

      “For many years, the only quality criteria used after a hernia operation was the recurrence rate. Subsequently, the tension-free concept was developed and is now used throughout the world. In recent years, the focus has increasingly shifted to possible chronic pain after hernia surgery. Based on these two criteria, the currently applicable “International Guidelines for Groin Hernia Management” published by the HerniaSurge Group recommends the use of mesh as a rule, either endoscopically via transabdominal preperitoneal or total extraperitoneal or in open surgery using the Lichtenstein technique.[1]

      However, newer studies have shown that use of the Lichtenstein technique is possibly linked to a higher rate of postoperative pain.[2] The guidelines currently do not include alternative open surgical techniques, particularly mesh-free techniques, due to the small amount of scientific evidence. However, in recent years, numerous reports on postoperative pain after mesh implantation[3] and mesh-related complications[4] have led to increasing uncertainty among patients. Moreover, there have recently been register studies that showed at least equally good results for the mesh-free procedures for selected patients.[5],[6] Thus, the mesh-free procedures are regaining importance.[7]”

      • #32787

        GI, maybe you have come across this somewhere…

        There was some mention recently of an institution considering amendments to its surgical training program, including more attention to tissue repairs ‘in part due to the desires of its young surgical students’ or something to that effect. I’m almost positive this was somewhere in Europe, but for the life of me I can’t recall where I read it and it doesn’t seem to be in any of the articles I’ve saved.

        All I remember is that this was more of a side note in the discussion rather than the focal point of the article, which unfortunately makes it harder to find…but it was good to know that there was some desire for institutional training rather than having to seek it out later.

    • #32778

      HerniaSurge provided their updates at this week’s European Hernia Society meeting in Manchester. Go to my Twitter account, as I am live tweeting from the meeting, to read more. The official publication is coming up soon.

    • #32784
      Good intentions

      Thanks Dr. Towfigh. You might not be aware that people without Twitter accounts can only see a few Tweets before Twitter blocks access to the site, until the person signs in or signs up. So your EHS live tweets will soon be unviewable to people without accounts, as you add other tweets behind them.

      The Guidelines on the EHS web site have not changed (https://www.europeanherniasociety.eu/ ). The 2018 version is still up. I assume that EHS will update them, and their summary of them, as soon as possible. (I just noticed that Medtronic managed to get their name on to the Guidelines summary page, at the end. The Guidelines should really be called “Guidelines for Mesh Repair of Hernias”. https://www.europeanherniasociety.eu/sites/www.europeanherniasociety.eu/files/medias/cov13178_ehs_groin_hernia_management_a5_en_10_lr_1.pdf)

    • #32785
      Good intentions

      The Herniasurge web page is still inactive, and their Facebook page has no activity either.

      I hope that something good happens but history suggests that the effort will be mainly to reaffirm what has already been created, as shown by their very recent survey of surgeons to reaffirm (or really, just to affirm) support of the Guidelines. Why would they do that if significant changes were in progress? Any changes would be used by the lawyers for current lawsuits. I will be surprised if there is any suggestion to reduce the use of mesh. It’s just how corporations work.

      Good luck with your efforts to drive change for hernia repair for women. I think that there is real possibility there since the volume is so small compared to male hernias.



    • #32796
      William Bryant

      Mart T it rings a bell with me tok I do recall Dr Pawlak from NHS in UK wrote tissue repair should be considered for small hernias but can’t remember if he said training too.

    • #32797
      Good intentions

      I don’t remember anything specific to Mark T’s comment but I did post something in the past about Dr. Pawlak and his views on Guidelines. He was on the presentation list at the Manchester conference.

      The Manchester conference seems primed to drive change but Dr. Pawlak’s editorial shows why what the Herniasurge group manufactured is so powerful. They have defined an artificial “standard of care” that perpetuates the use of mesh for hernia repair. I think that that is why they get so much support from companies like Medtronic. If I was an executive at Medtronic I would be all-in on helping the Herniasurge group get heir message out. Full funding, whatever they need.

      Here is my old Topic. I will pull out the Editorial in the post after this.

      Dr. M. Pawlak – a new surgeon worth following (and hoping for)

      And the Topic about the Manchester conference.

      European Hernia Society Manchester 2022

    • #32798
      Good intentions

      It would have been interesting to see how Dr. Pawlak’s views were received at the conference. Herniasurge on one side, promoting mesh, others expressing solid counterpoints.


      Here is their final paragraph –

      “Guidelines – friend or foe? Guidelines that conform to current development standards should be our friend. There seems to be a fear among many herniologists that guidelines set a standard of care. And deviation from them will thus become ammunition for patients and their lawyers to trip us up. This is a view that is very wrong, both for what guidelines are for and what they mean. We end this editorial with the words of John Kinsella, recently retired Chair of the Scottish Intercollegiate Guidelines Network (SIGN). “In the era of realistic medicine, SIGN guidelines should be the starting point for decision-making at the clinician-patient interface, and should inform the joint decision, not dictate a particular course of action.”[21]”

    • #33284
      Good intentions

      Still nothing. Running out of time.

      All there is are updated incisional closure guidelines. Or singular “guideline” as they label it.



    • #33322
      Good intentions

      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”

    • #33849
      Good intentions

      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.



    • #33943
      Good intentions

      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.


    • #33987
      Good intentions
    • #34354
      Good intentions

      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 ago


      HerniaSurge #InguinalHernia updates guidelines team discussing recommendations. Publication this year!”

    • #34383
      Good intentions

      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.



      J. Abdom. Wall Surg., 27 March 2023
      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.”

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