**4. Things we must do for patients**

factual content related to "hernia center," it is clear that this term is being used loosely as a potential trigger to mislead patients into believing that they are getting proper treatment from

I propose a new model for integrating modern surgical hernia centers network to continue pioneering independent efforts to further expand modern surgical care for patients with hernias. Many hospitals and surgery centers offer hernia repair—but most of the patients would not receive the same results and level of personal care everywhere. Hernia centers will offer a hernia repair from a leading surgeon who provides unmatched expertise and state-of-the-art treatment options. For patients, this means a positive and happy experience, a swift return to

The first strategy would be the creation of hernia departments within the major hospitals in the university cities by accessing European funds or charity. The departments should be run by a team of specialized surgeons and nurses who will take charge of the patient. A platform for improving health-care delivery around the world should be created. One way to manage these expectations is to create a strategic plan that clearly outlines goals for the future and how to reach them. In every country, there are less equipped hospitals and hospitals with a high level of training and equipment. The consultants will assume the responsibility in keeping contact with all hospitals, to take charge of patients, to attend conferences, and to participate in clinical trials to collaborate for the benefit of the patients. The idea is that depending on the hospital conditions and the particularities of the case, the patient is referred to a specialist in the country or in another country. The most important is that the patient will be staying in contact with his/her surgeon. The second suggestion would be to create specialized centers: hernia centers in each country which gather surgeons focusing on hernias. As thousands of new cases are being added each year, centers are able to offer the best possible treatment options available in all hernia-based cases. This project will provide opportunities for patients to be treated by true experts in hernia field, but also for surgeons to maintain a record of operated patients, the type of surgery performed, the complications that occurred, and the complexity of the cases with their particularities. The analysis of this information will lead to improved surgical services by creating a relevant statistic which will help us to make hernia protocols. A "hernia center" is

normal life, and a lower risk of discomfort and complications.

capable of continuous improvement focused on a magnitude of experience.

Surgeons who will work in these centers will be experienced in treating primary and recurrent hernias using both open and laparoscopic methods. The hernia center will be equipped with the newest techniques and materials in hernia repair. The center should be available to patients for consultation, surgical treatment, follow-up, or just for questions, and should provide appointments and international collaboration. Hernia center should provide assistance

Abdominal wall reconstruction, proper care of recurring hernias, pain prevention, treating hernias with enterocutaneous fistulas, complex mesh-associated infections, and mesh reconstructions require specialized treatment plans that can be established by team members using

certified private institutions [9].

14 Hernia Surgery and Recent Developments

also for emergency situations.

laparoscopic and modern hernia repair techniques.

**3. Hernia physicians**

Providing care for poor people, persons who are not insured, undocumented immigrants is an issue, particularly in developing countries or very poor neighborhoods from different countries. Physicians can also volunteer their time to care for these patients, and how a physician handles a situation may depend on the specific case, and the most important thing is to focus on the international collaboration.

We should place greater importance on providing preventive care: teaching patients to eat right and exercise, and compensating health-care professionals for providing that care. It is important for physicians to remove their personal agenda or bias when helping patients understand their options and make good health-care decisions. In other words, we cannot only rely on old-fashioned forms of caring for patients. It is increasingly important that we care for patients in new ways and pay health-care professionals to do so. Surgeons should place value of care as a priority, thus creating a patient-centered approach which would place a priority on the quality of care rather than volume. Safe surgery involves avoiding complications or adverse events that can arise before, during, and after surgical procedures and most importantly avoid any danger of exposure to disease while they are in a vulnerable, postoperative state. Thus, safety measures are implemented before anesthesia, before incision, during surgery, and in the provision of postoperative care.

maintenance might be a financial obstacle to implementation, especially when compared with complex public health interventions. The high cost, infrastructure demands, and complexity of implementing surgery compared with other public health interventions are challenges, but they are not insurmountable. In addition to providing common surgical items, medical device manufacturers could make a real impact by developing high-quality easily serviceable devices for all aspects for surgical care, instrument sterilization equipment, and monitoring

International Surgical Collaboration in Hernia Repair for the Benefit of the Patients: Things We…

http://dx.doi.org/10.5772/intechopen.76906

17

Funding is a big issue which needs to be considered seriously. Every recurring incident of a hernia-related operation places a significant financial weight on the health-care system and it may even lead to further problems for the patient. Cost-benefit analysis will always report that by correctly treating the patients with proper conditions, complications will be avoided. Economic losses can be reduced by quantifying the risks, especially in groups of patients who may be more prone to complications and by applying prophylactic measures. Typical forms of economic analysis include cost analysis per individual procedure, efficient spending related to the financial values of standardized medical outcomes, and the associated social benefit that involves the reductions of cost to an individual who has undergone an operation and society as a whole. Fundamental knowledge of the financial value of health interventions is crucial for policy makers to make proper decisions related to the allocation of resources.

Although there are increasing funding opportunities, mainly via philanthropic organizations, some nongovernmental organizations (NGOs), and even governmental organizations, the sheer problem is so huge that more is continually needed. There are many different policy options to ensure the successful development of these chains of specialized centers, but what works for one country may not work for another. The EU provides funding for a broad range of projects and programs covering areas such as research & innovation or humanitarian aid. The EU has been providing humanitarian aid since 1992 in over 140 countries. EU-funded humanitarian assistance is implemented through humanitarian organizations. These are European NGOs, UN agencies, and International organizations. Because in each country the national governments manage the funding, a proposal would be that, through the European hernia society, unanimously obtain funds for each member country and form a network between centers. A project based on the work of an international team aiming to help

Special attention should be paid to internationally collaborated work identified based on the creation of centers or specialized departments. With the involvement of various international organizations, policy makers, health-care managers, and other stakeholders, a collaborative approach can be achieved in order to accelerate progress toward an improved and sustainable surgical care. It can often be found that various charitable groups are primarily responsible for the proper delivery of medical and surgical care in both less developed and developing countries. Lately, many surgical organizations have appeared but who keeps track of them and their results, who monitors their outcomes, who controls them to ensure the quality of the materials used in the mission, and most of the volunteers are not hernia experts. In the published literature, we find immediate results of the mission in question, and almost all missions have very good results without complications. To determine their real collective contribution,

machines.

the society has more chance to succeed.

a comprehensive database of these groups is needed.

The need for a greater regionalization of care, the use of telemedicine, and providing incentives to relocate where patient needs is the greatest merit that requires further exploration.

Existing guidelines, which often reflect the values and practices of a particular region, have not yet achieved this goal. Accurate assessment of quality in hernia repair also will require a better long-term follow-up worldwide.

The network will aim to promote a systematic guideline development and implementation which "seeks to improve the quality of health-care by promoting systematic development of clinical practice guidelines." Professionals from all countries should join together to form networks for the rapid exchange of information on outbreaks. Networks, focusing on a wide particularity of the case, the possibility of repair, availability of medical supplies, medical strategies, and so on such as the European Working Group for Legionella Infections (EWGLI) or the European Influenza Surveillance Scheme (EISS), form the basis of international cooperation on communicable diseases within the European Union [10]. A specific example comes from New York City about how social media, specifically the International Hernia Collaborative, has changed the way surgeons communicate and collaborate with one another to help patients [11]. The start can be given the EHS-GREPA which has representative members from each country, including the International Hernia Collaboration (IHC) (more than 2500 members) created by panelist Brian Jacob, MD. The creation of these social media communities is invaluable for sharing knowledge and varied perspectives, social/professional support, rapid communication dissemination, and advancement of innovative solutions and improved patient care. The thing is that in one country, there are multiple centers which must communicate, and when a situation goes beyond their country should be able to get in touch with a hospital from other country for the benefit of the patient. International Patient Program should provide advanced diagnostic, medical, surgical, and rehabilitative specialty care to patients from around the world. The health-care providers will work together as a team with each patient at its center—to provide the most effective and compassionate care, always.

### **5. Surgery and poverty**

Surgery in low-income and middle-income countries faces implementation challenges. Compared with vaccination or antiretroviral treatment, surgery needs more infrastructures for example, clean operating rooms, anesthesia, electrical power for monitoring equipment, and ancillary laboratory services. The infrastructure investment and the recurring cost of its maintenance might be a financial obstacle to implementation, especially when compared with complex public health interventions. The high cost, infrastructure demands, and complexity of implementing surgery compared with other public health interventions are challenges, but they are not insurmountable. In addition to providing common surgical items, medical device manufacturers could make a real impact by developing high-quality easily serviceable devices for all aspects for surgical care, instrument sterilization equipment, and monitoring machines.

understand their options and make good health-care decisions. In other words, we cannot only rely on old-fashioned forms of caring for patients. It is increasingly important that we care for patients in new ways and pay health-care professionals to do so. Surgeons should place value of care as a priority, thus creating a patient-centered approach which would place a priority on the quality of care rather than volume. Safe surgery involves avoiding complications or adverse events that can arise before, during, and after surgical procedures and most importantly avoid any danger of exposure to disease while they are in a vulnerable, postoperative state. Thus, safety measures are implemented before anesthesia, before incision, dur-

The need for a greater regionalization of care, the use of telemedicine, and providing incentives to relocate where patient needs is the greatest merit that requires further exploration.

Existing guidelines, which often reflect the values and practices of a particular region, have not yet achieved this goal. Accurate assessment of quality in hernia repair also will require a

The network will aim to promote a systematic guideline development and implementation which "seeks to improve the quality of health-care by promoting systematic development of clinical practice guidelines." Professionals from all countries should join together to form networks for the rapid exchange of information on outbreaks. Networks, focusing on a wide particularity of the case, the possibility of repair, availability of medical supplies, medical strategies, and so on such as the European Working Group for Legionella Infections (EWGLI) or the European Influenza Surveillance Scheme (EISS), form the basis of international cooperation on communicable diseases within the European Union [10]. A specific example comes from New York City about how social media, specifically the International Hernia Collaborative, has changed the way surgeons communicate and collaborate with one another to help patients [11]. The start can be given the EHS-GREPA which has representative members from each country, including the International Hernia Collaboration (IHC) (more than 2500 members) created by panelist Brian Jacob, MD. The creation of these social media communities is invaluable for sharing knowledge and varied perspectives, social/professional support, rapid communication dissemination, and advancement of innovative solutions and improved patient care. The thing is that in one country, there are multiple centers which must communicate, and when a situation goes beyond their country should be able to get in touch with a hospital from other country for the benefit of the patient. International Patient Program should provide advanced diagnostic, medical, surgical, and rehabilitative specialty care to patients from around the world. The health-care providers will work together as a team with each patient at its center—to provide the most effective and compassionate care, always.

Surgery in low-income and middle-income countries faces implementation challenges. Compared with vaccination or antiretroviral treatment, surgery needs more infrastructures for example, clean operating rooms, anesthesia, electrical power for monitoring equipment, and ancillary laboratory services. The infrastructure investment and the recurring cost of its

ing surgery, and in the provision of postoperative care.

better long-term follow-up worldwide.

16 Hernia Surgery and Recent Developments

**5. Surgery and poverty**

Funding is a big issue which needs to be considered seriously. Every recurring incident of a hernia-related operation places a significant financial weight on the health-care system and it may even lead to further problems for the patient. Cost-benefit analysis will always report that by correctly treating the patients with proper conditions, complications will be avoided. Economic losses can be reduced by quantifying the risks, especially in groups of patients who may be more prone to complications and by applying prophylactic measures. Typical forms of economic analysis include cost analysis per individual procedure, efficient spending related to the financial values of standardized medical outcomes, and the associated social benefit that involves the reductions of cost to an individual who has undergone an operation and society as a whole. Fundamental knowledge of the financial value of health interventions is crucial for policy makers to make proper decisions related to the allocation of resources.

Although there are increasing funding opportunities, mainly via philanthropic organizations, some nongovernmental organizations (NGOs), and even governmental organizations, the sheer problem is so huge that more is continually needed. There are many different policy options to ensure the successful development of these chains of specialized centers, but what works for one country may not work for another. The EU provides funding for a broad range of projects and programs covering areas such as research & innovation or humanitarian aid. The EU has been providing humanitarian aid since 1992 in over 140 countries. EU-funded humanitarian assistance is implemented through humanitarian organizations. These are European NGOs, UN agencies, and International organizations. Because in each country the national governments manage the funding, a proposal would be that, through the European hernia society, unanimously obtain funds for each member country and form a network between centers. A project based on the work of an international team aiming to help the society has more chance to succeed.

Special attention should be paid to internationally collaborated work identified based on the creation of centers or specialized departments. With the involvement of various international organizations, policy makers, health-care managers, and other stakeholders, a collaborative approach can be achieved in order to accelerate progress toward an improved and sustainable surgical care. It can often be found that various charitable groups are primarily responsible for the proper delivery of medical and surgical care in both less developed and developing countries. Lately, many surgical organizations have appeared but who keeps track of them and their results, who monitors their outcomes, who controls them to ensure the quality of the materials used in the mission, and most of the volunteers are not hernia experts. In the published literature, we find immediate results of the mission in question, and almost all missions have very good results without complications. To determine their real collective contribution, a comprehensive database of these groups is needed.
