Presidents Message

Presidents report 2018

Another year older and hopefully wiser.  The BHS continues to grow, with a 50 % increase in membership during 2017 to 900 members.  The BHS has now a well established Twitter feed with over 500 followers at the time of writing.

2018 is a bumper year for BHS events.  We have linked with AWREurope (February), through Al Windsor.  We have also linked to the Hernia Controversies Conference (March), through Aman Bhargarva.  The BHS has representation at ASGBI (May).  And then the biannual BHS meeting is this year in Edinburgh, 5/6 November.  The themes for this meeting is the Emergency management of the Abdominal Wall, and Hernia dilemmas for the surgeon.  We hope you will all support these meetings.  We also think that Manchester has been successful in their bid for EHS 2022, with Aali Sheen leading the charge on this.  Another date to get in the diary!

The first International Guidelines on groin hernia have been published. The BHS had representation with myself and David Sanders on the guideline group.  A link to this guideline is on the BHS website, and will be free to download until the end of April 2018. After that, access to the Journal Hernia will be required.  An easy way to get this access is to become a member of the European Hernia Society (which you can via their website, currently 80€ a year).  Such guidelines are compulsory reading!  The European Hernia Society also published guidelines on parastomal hernia.  An update on closure of the abdomen, and guidelines for the management of the open abdomen are also planned.  I do encourage you to become members of the EHS.

Talking of the Journal Hernia, its editorial structure has been reorganised.  The journal will have 10 sections, and myself and David Sanders have accepted positions as Section Editors.  A lot of work has taken place around time to review of submitted papers, and I encourage you all to submit your hernia research to this journal.

The hot topic of the year appears to be mesh and its safety versus harm in hernia repair.   There is a growing lobby against mesh, and no doubt the issue over the use of mesh by gynaecologists is partly fuelling this debate.  In the end of the day, mesh versus no mesh is part of the discussions around what operation and thus informed consent with every patient.  Surgeons/units will need to ensure that they offer non-mesh repairs, or establish referral practices to units that do. #livelifemeshfree is a message you will see and hear a lot more of in the near future.  The BHS hopes to remain at the forefront of this debate in the UK.

We have also seen some interesting papers and discussion around the worth of inguinal hernia repair in the majority.  This has impacted on some interesting Commissioning plans by some regions.  Watchful waiting has a place in some patients, but we support this discussion with patients at surgeon level, rather than a blanket non-referral policy.  Emergency hernia surgery is high risk surgery and we need to be mindful of this.

Hernia remains the orphan speciality, often seen as ‘just a hernia’.  While this is true for many inguinal and ventral hernia, the complex abdominal wall reconstruction should focus in the hands of the few, to try and improve outcomes.  I think this is happening to a degree, but remember, the best time to repair an incisional hernia is the first time!

I will end with apologies to Ewan McGregor and Trainspotting.  These are my resolutions for 2018 and beyond:

Choose live life mesh free.  Sometimes.

Choose mesh – often.

Choose mesh with proven clinical benefit

Choose large pore mesh.

Choose mesh with anti-adhesion properties when needed.

Choose which operation carefully – when, how and on whom.

Choose fixation with the patient at heart.

Choose fixation for less pain and less recurrence.

Choose PROMS, and ask the right questions.

Listen to patients, get informed consent.

Read guidelines.

Choose best practice and avoid litigation.

Choose your future.

Choose life.