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

[Good intentions]

Still nothing. Running out of time.

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

https://linktr.ee/EHSguidelines

https://www.linkedin.com/posts/european-hernia-society_inguinalhernia-euroherniasnews-herniaguidelines-activity-6970116740076732416-3hGD/

• This reply was modified 1 year, 12 months ago by  Good intentions.

[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.

https://www.herniasurgeryjournal.org/article.asp?aulast=Pawlak&epage=77&issn=2589-8736&issue=3&spage=75&volume=2&year=2019

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]”

[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.

https://herniatalk.com/forums/topic/dr-m-pawlak-a-new-surgeon-worth-following-and-hoping-for/

And the Topic about the Manchester conference.

https://herniatalk.com/forums/topic/european-hernia-society-manchester-2022/

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

[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.

[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.

https://twitter.com/Herniadoc?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor

https://twitter.com/eurohernias?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor

[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)

[drtowfigh]

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.

[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.

https://www.herniasurgeryjournal.org/article.asp?issn=2589-8736;year=2019;volume=2;issue=1;spage=23;epage=24;aulast=Lorenz

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]”

[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.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048651/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719730/

[drtowfigh]

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.

[Good intentions]

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

[MarkT]

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.