ANZ Hernia, a new society, is inviting general surgeons to be involved in its forthcoming election of office bearers.
Hernia is a common and major health issue in Australia and New Zealand. Approximately 60,000 patients have hernia surgery annually at a cost of more than $350 million. Despite the use of prosthetic mesh in most ventral and incisional hernia repairs, the long-term recurrence rate remains unacceptably high. While complication rates (chronic pain, recurrence, infection) for common hernia procedures are low—given the large number of procedures performed—a substantial number of patients suffer with chronic disabilities.
With increased media exposure and legal proceedings arising from uro-gynaecological mesh implants, patients are concerned about the use of mesh in hernia repair. This has highlighted the low quality of evidence available on safety, effectiveness, and morbidity of meshes, including concerns about governance and post-insertion surveillance. The result—a significant loss in consumer confidence. Consequently, the Therapeutic Goods Association (TGA), has recently reclassified mesh in line with EU recommendations—mandating strict criteria before registration of mesh for human use and a rigorous process to monitor post insertion surveillance.
Currently, hernia surgery is undergoing substantial change. Many new techniques are being introduced, including advanced Abdominal Wall Reconstruction (AWR) procedures, robotics, and new prostheses, all of which require evaluation.
Attempts at forming a dedicated hernia craft group within Australia have largely been stillborn. However, a few surgeons continued to work on a more formal structure and formed the ANZ Hernia in Australia. The working group has established strong connections with the American Core Health collaborative, TGA, Safety Commission and the AWR Surgeons community. Endorsed by the College and supported by surgeons from both countries, the ANZ Hernia Society aims to foster improved education, training, and clinical and basic scientific research. It will also maintain a nationwide database of hernia outcomes, administer a mesh registry, and importantly advocate on behalf of surgeons for more equitable reimbursement to reflect the time and effort involved in complex procedures.
Currently the office bearers of the steering committee are self-selected and includes Dr Chris Hensman, Dr Alex Karatassas, Dr Ken Loi, Dr David Wardill, Dr Su Mei Hoh, Dr Harsha Chandraratna, Dr Ross Roberts, Dr Anita Jacombs, and Dr Rodney Jacobs. “We plan to hold elections January-February 2022 for a committee of 10—president, vice president, secretary, treasurer, education, and research chairpersons. Surgeons will be able to email their nomination to our secretariat and website,” Dr Jacobs said.
In 2019, ANZ Hernia co-hosted the Adelaide Hernia meeting along with the ANZAWR 2020 and ANZAWR 2021 virtual meetings held in conjunction with the AWR Surgeons from India. A third meeting, ANZAWR III, focussing on mitigating the risks in hernia surgery, took place in late November. The group has already commenced a journal club, been involved in several recent publications in Hernia and the ANZJS, initiated several research projects, and is looking to develop dedicated training posts in hernia surgery.
ANZ Hernia have been closely involved in the soon to be published RACS rapid review of the safety of mesh, have established links with MD Epinet, a device epidemiology organisation based in the US and along with a local firm, Data Dissect, have established the ANZ Hernia Clinical Quality Registry (CQR). It will oversee the registry to track hernia and mesh outcomes in Australia and New Zealand.
The CQR pilot program, endorsed by Australian Safety and Efficacy Register of New Interventional Procedure (ASERNIP), the TGA and the Abdominal Core Health Quality Collaborative (AHSQC), will go live in South Australia in November, and will be rolled out Australasia wide over the next couple of years. It will provide a unique platform incorporating a novel learning system to allow both surveillance of implants and monitor the efficacy of various methods of hernia repair. ANZ Hernia will play an important role in maintaining standards with its oversight and governance functions.
As an independent, bi-national craft group, it will facilitate communication with the College, government, industry, and consumer groups. It gives hernia surgery a greater voice and a focus to lobby for more equitable reimbursement to reflect the time and effort involved in complex procedures. “By engaging with government and consumers, ANZ Hernia will endeavour to restore consumer confidence in mesh mediated hernia repair,” Dr Jacobs said.
ANZ Hernia is inviting all general surgeons to be involved in ANZ Hernia and the ANZ Hernia Quality Registry. The forthcoming election of office bearers is your chance to participate in the development of this new society.