Starting from early years 70', GREPA organisation first, and than (EHS) European Hernia Society have try to give knowledge and suggestions about the solution of hernia problem. The Tsunami that involved the surgical world about new techniques, new materials and the pressure applied from industries developing new devices, has produced dozens of personal techniques using different surgical ways (open anterior with or without prosthesis, laparoscopic TAPP or TEP), dozens of prosthetic materials (lightweight, heavyweight, non absorbable, semi absorbable), creating the false idea that the personal technique used would be the one, without complications, low recurrence rate, and no post herniorrhaphy pain. This is not true. Complications occurs, and recurrences and pain as well. The only EBM validated result has defined that Prosthetic repair is better that pure tissue repair and laparoscopic techniques are more comfortable than open repair, in the first period after surgery. I think that the "the end" word about hernia surgery are still so far to be written

I absolutely agree!

We need databased research including large scale numbers of patients, using standardized surgical techniques following clear EBM guidelines (EHS) and comparable follow up according to the hernia database management system. And we need certified centers.

Therewith we can account for three aims:

1. quality research of you own institution

2. provide requirements for certification process of the institution

3. outcome research of new devices.

What quality markers would you suggest?   For inguinal hernia, perhaps these

Day case rate

Rates of laparoscopic repair for bilateral inguinal and recurrent hernias?

Chronic pain rates (what definition?)

Reoperative rates (haematoma /  bowel injury / reasons other that recurrence)

Readmissions

Recurrence rate at 5 or 10 years?

Certainly an interesting discussion. 

Quality are not defined yet. A first step is continuous documentation of all in-hospital data (e.g. base line, intraoperative data, postoperative data) and mandatory follow-up intervals up to 10 years. Definitely, according to patients needs, pain, recurrence rate and re-operation rate are one of "quality" items of utmost importance. 

We joined the biggest european hernia database recently (www.herniamed.de), which is coming up with an english version soon. Herniamed was founded 2009, so more then 380 hospitals are associated. First 5-year follow-up data with large scale patient numbers will be published soon. 

A comment from an other point of view, that of quality management.

Strictly speaking, there is no question of quality management yet. Quality management emerges as there is agreement on the best method(s) (where the customer, the patient benefits most I guess). Then quality management is there to ensure the procedure(s) of that particular best method or methods with defined specific measures, so that at all times the desired result is achieved.

To find the preferred method, the approach to create a database is indeed suitable, if there is in any case consensus on the criteria against which the different methods are tested ultimately.

Hernia repair is one of the basic surgical practice.although there are a lot of surgical techniques either open or laparoscopic you have to master and adopt the most suitable to the patient and the more ergonomic to you so,regular and organized practice is essential that means quality management is an integral part to improve the outcome.

Yours

Simple answer yes we do.Hernia surgery is common overall morbidity is likely higher both short and long term. Hernia database and outcome measures etc is long overdue. Whilst in the UK we are currently using PROMS, the data from this will not address a lot of potential issues underlying poorer patient outcome.

It would be difficult to argue against the need for more data, as in most situations. The question is what type? In the UK, we have a well developed and integrated health system where general practitioner refer patients to hospital and also look after them if any problems arise after surgery. So my research is now looking at linked hospital and primary care databases to evaluate negative outcomes from hernia surgery on a national scale. In my view, the future is integrating and linking routinely collected data, rather than registry which is usually associated with high costs. 

Swedish Hernia Registry and Danish Hernia Database:

Both cover essential hernia repair data from entire (albeit not the largest...) nations.

Both have generated many high quality papers in top ranked surgical journals. Read and enjoy!

The RCS England have published a document which includes at the end some 'quality' specifications.   

https://www.rcseng.ac.uk/healthcare-bodies/docs/published-guides/hernia     

Its not amazing, but these criteria are designed to be easily obtained using administrative databases.

Cheers

Ewen

When defining quality of hernia surgery, we have to consider recurrence rate, frequency and severity of complications, postoperative discomfort and rehabilitation. In today’s industrialised world, in which facilities cannot meet demands, surgical quality may be defined as the fulfilment of aims at a minimum cost. In the management of groin hernia, surgery alone is responsible for frequency of recurrence and postoperative complications, whereas convalescence is to a large extent affected by advice given to patients and socio-economic factors. When patients are asked whether they consider avoidance of recurrence of hernia or speed of recovery to be the most important outcome, the great majority regard avoidance of recurrence as the most important. Hence surgeons should do their utmost to prevent recurrence following hernia surgery, while at the same time undertaking all efforts to make convalescence as short and free from discomfort and pain as possible.

Yes, we do need quality management.Hernia being a common surgery done by specialists,General surgeons and trainees and we have different open techniques and

and lap TAPP and TEP.How is to get quality management ?

I think, claiming to work as a quality center for hernia surgery includes starting recording data of all hernia patients, procedures and complications. It also requires long term follow-up up to 10 years afters surgery. This is not the fact in the vast majority of clinics, which deal with hernia patients.  

We need to know what we actually do, and whether we follow evident guidelines etc. Only if all those requirements are fulfilled, we can speak about a quality center of hernia surgery.

I do agree with Henry,this is possible only in centers practicing only Herniology.However evidence based guide lines are ideal to practice and to follow up.This may not be possible in most of the centres.

BIGG YESS....despite its common nature and the fact that even the corner butcher can claim he could repair it, it is most often a simple procedure but on occasions it can lead to disastrous complications and even death. 

Of course we need to implement TQM, ISO 9001-2008, in hospitals and therefore the activity of surgery regardless of the profile sections. TQM requires the development of procedures, including the procedure for inguinal hernia operation. The strict application of this procedure doctors did not derail the patients. Heads Up! exist important achievements in implementing ISO 9001 in the medical system

Depending on the health care insurance system, most health care providers will claim quality controll of all surgical procedures soon. This is even more important, since especially hernia surgery is undertaken by almost every general surgeon, and some advancing techniques have made their way into daily practice (TEP, TAPP). There is no other way to make sure that Quality is provided based on accepted Guidelines. 

Furthermore, I think several general surgeons are not able to provide the recommended "tailored apporach" of inguinal hernia surgery, because it requires proficiency in all hernia techniques, including the demanding TEP and TAPP. Here, Quality Management may help to overcome apprehensions towards new techniques, such as TEP and TAPP.

Starting from early years 70', GREPA organisation first, and than (EHS) European Hernia Society have try to give knowledge and suggestions about the solution of hernia problem. The Tsunami that involved the surgical world about new techniques, new materials and the pressure applied from industries developing new devices, has produced dozens of personal techniques using different surgical ways (open anterior with or without prosthesis, laparoscopic TAPP or TEP), dozens of prosthetic materials (lightweight, heavyweight, non absorbable, semi absorbable), creating the false idea that the personal technique used would be the one, without complications, low recurrence rate, and no post herniorrhaphy pain. This is not true. Complications occurs, and recurrences and pain as well. The only EBM validated result has defined that Prosthetic repair is better that pure tissue repair and laparoscopic techniques are more comfortable than open repair, in the first period after surgery. I think that the "the end" word about hernia surgery are still so far to be written

Do we need Quality Management in Hernia Surgery? - ResearchGate. Available from: https://www.researchgate.net/post/Do_we_need_Quality_Management_in_Hernia_Surgery/1 [accessed Mar 31, 2016].

Thanks Giorgio J am in agreement  many way has done in reparation of inguinal hernia, It not exist a technique for all hernias. Only the experience of the surgeon take on the best technique for that patient.. Today we talk many of  "tailored surgery" every interventetion must done for that patient