**2. International hernia centers and surgical care**

Millions of hernia operations are performed each year, making hernia the world's most common of all surgical operations. The increased number of patients with hernias led to the need for a specialized surgical field. In adults, the only treatment for a hernia is surgical, and there are several different approaches with different results. The aim consists on patients getting access to the care or service they need, no matter where they are, regardless of their material

When deciding which surgical service to offer facility capabilities and infrastructure must be considered. A well-equipped facility is necessary to support a strong education program in undeserved areas. According to the World Health Organization Safe Surgery Initiative, operating theaters must be of adequate size, have appropriate lighting, and have dependable

Advancements in health-care always come down to collaboration. It benefits both the healthcare system and the population as it may provide new treatments which are probably not

By focusing on collaboration with institutions around the world rather than the simple provision of short-term services, hope is to promote a culture of training and investigation to be

There are no data in the study on the integration of surgical services within a health system or as a component of health system strengthening. Conceptual models should be proposed based on the international meetings, knowledge gained across the international collaboration, infrastructure or patient population, resources and materials, and knowledge transfer tools to facilitate communication. A preliminary model presenting a concept of surgical care integration within a health system is being presented in association with various medical literature resources that further the World Health Organizations vision of a health-care system

What if dedicated hernia experts would collaborate through hospital networks (hernia centers) committed to providing surgical excellence and best patient outcome. The opportunity to develop this hernia center networks would provide a hernia international collaboration:

**3.** if one of the hospitals has certain shortcomings, the patient can be referred to another

**5.** before surgery, the patient will be guided through the process and provided all of the in-

**6.** after surgery, follow-up by telephone or coming directly to the center will make sure that the patients are happy, healthy, and completely satisfied as returning to their normal

formation required to make informed decisions and plan for the procedure;

**1.** sharing knowledge and repair strategies among surgeons;

**2.** if a surgeon has doubts about a case, he may ask for guidance;

**4.** practice will attentively guide the patient and caringly support him;

situation.

model [8].

hospital;

activities;

electricity and water to a minimum [7].

12 Hernia Surgery and Recent Developments

already available in that country [6].

shared equally among all partners.

I want to reinforce the statement made by Dr. Halfdan Mahler: that surgery has a key role in health-care, and unfortunately although medicine has evolved so much lately by getting to work with robotics, body parts transplants, the appearance of new different surgical materials, the majority of the world's population has no access whatsoever to skilled surgical care because of the poverty. Much more can be done if we share common goals meet in working, learning, practice, all for the benefit of the patients.

Conventional solutions are not likely to be very satisfactory. So what should the international surgical community do?

The magnitude and importance of achieving solidarity and cooperation in an interdependent world calls for a major program and considerable support. For decades, hernias have been managed by all general surgeons, but now top-tier medical systems are recognizing the value of standalone hernia centers, staffed with physicians equally adept at open surgery and minimally invasive techniques.

Hernia literature is more and more focusing on developing surgery techniques, discussion focused mostly on surgical meshes, mesh repair versus tissue repair, robotic surgery, roboticassisted procedure versus the laparoscopic approach and so on. What about hernia healthcare system? A commitment to patient care and success necessitates that the requirements be comprehensive, research-based, and verified through a rigorous site inspection?

Even if private institutions began to greatly develop the terminology of "hernia center" as not yet well understood, that is why it is more used as a marketing instrument. Google has approximately 6,560,000 links associated to "hernia center" from a single search inquiry. There are very few scientific articles in which the term "hernia center" is explained as a model of how surgical care might be integrated within a health system. As a result of this lack of 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 certified private institutions [9].

The fear of patients and inexperienced surgeons is mainly focused on how to deal with the complications that occur after surgery. Recurrence after primary hernia repair or the complexity of the case due to its particularities highlights the need for hernia experts. A surgeon has many qualities but being patient and calm can be reflected in the way patient is treated: to be listened and understood, to receive all the required answers, and to understand the treat-

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

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

15

Multidisciplinary experts work in a team environment to serve each patient's unique needs with an individualized care plan. The physicians not only treat patients but conduct scientific

The aim of these departments/centers will be focused on finding personalized solution to help the patient to return to an active, pain-free life. The surgeons are particularly skilled in assess-

The hernia center will offer the full range of surgical options to repair hernias. Most hernia repairs are, by surgeons' standards, relatively straightforward and uncomplicated. Some, however, are more complex because of their size or because they occur at the site of a previous surgical incision that has not healed adequately. The hernia team will repair all types of hernias, including inguinal hernia, femoral hernia, umbilical hernia, incisional hernia, spigelian hernia, obturator hernia, epigastric hernia, hiatal hernia, and diaphragmatic hernia. Minimally invasive surgery such as laparoscopy is generally better for patients—less pain, faster recovery—but it demands additional training for the surgeon. Open inguinal hernia

ing hernias and determining their appropriateness for open or laparoscopic surgery.

repairs will be possible to perform as an outpatient procedure under local anesthesia.

Surgical team should include general surgeons and plastic surgeons, as well as clinical and support professionals collaborating to provide a comprehensive care to patients. Surgeons will carefully plan surgery for each patient depending on the characteristics of the hernia and the comorbidities of the patient. Specialists are mastering the laparoscopy technique and are prepared to manage complications: hernia recurrence, pain after previous repair, hernias with enterocutaneous fistulas, mesh reconstruction, and complicated mesh-related infections. Complex or not, all patients wish their hernia to be treated by practitioners who perform more than 200 such procedures a year, instead of, say, 20 or 30? It is this type of experience that gives to patients a greater likelihood of an uncomplicated operation and a successful

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

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

ment options they have so that they will fulfill all the recommendations received.

research and teach the next generation of medical professionals.

outcome.

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

focus on the international collaboration.

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

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 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 also for emergency situations.
