**7. Certification processes**

Treating patients by nongovernmental organizations, performing surgery procedures that are not in conformance with the guidelines of the hernia societies, and by different volunteers, who are not properly trained sometimes under conditions not so favorable can lead to considerable complications for the patient and therefore additional costs for the society.

A primary necessity for valid certification of hernia centers includes a clear explanation of associated regulations and requirements and verification through either hernia societies and/or nonprofit organizations to ensure the optimal quality for hernia surgery. In addition, treatment quality must be verified through a certified center and it must be acquired through mandatory participation within a quality guarantee program or registry that includes a follow-up with patients.

Certified Center of Excellence in Hernia Surgery (COEHS) means a rigorous center of excellence program based on the effectiveness of the experts—well-trained hernia surgeon members of hernia societies fully committed to hernia field and properly equipped to ensure efficiency of technical care worldwide. Hernia centers will improve the follow-up of the patients gathering data through which we can create an international database. Health-care system is changed by international protocols which are deliberated after a long research with significant impact. That is why we need hernia centers to support us by facilitating our work and especially to ensure quality treatment to all patients.

Hernia centers should be certified by the European Hernia Society (EHS)/Americas Hernia Society (AHS)/Asia Pacific Hernia Society (APHS) depending on the country in which the center will be built. Member representation and participation in these committees is of critical value and can serve as a stepping stone for senior leadership roles within the society.

German Hernia Society presents a model on how hernia centers should become certified through a Certified Hernia Center program which is very well explained in an article [9] published in 2014. We can also take the model of cancer institutes, which focuses only on cancer pathology. There are not many definitive consensuses in hernia field concerning prevention, which surgical technique is best, non-mesh repair versus mesh repair, robotic versus laparoscopic approach for ventral hernias, and the possibilities of repairing hernia recurrences. That is why an individualized, patient-centered approach is needed, and how can you achieve it better than by setting up hernia centers. These initiatives based on collaboration and globalization must become our future target focused on improving care for all hernia patients.
