Defining the characteristics of certified hernia centers in Italy: The Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences

Background: The terms “Hernia Center” (HC) and Hernia Surgeon” (HS) have gained more and more popularity in recent years. Nevertheless, there is lack of protocols and methods for certification of their activities and results. The Italian Society of Hernia and Abdominal Wall Surgery proposes a method for different levels of certification. Methods: The national board created a commission, with the task to define principles and structure of an accreditation program. The discussion of each topic was preceded by a Systematic Review, according to PRISMA Guidelines and Methodology. In case of lack or inadequate data from literature, the parameter was fixed trough a Commission discussion. Results: The Commission defined a certification process including: “FLC - First level Certification”: restricted to single surgeon, it is given under request and proof of a formal completion of the learning curve process for the basic procedures and an adequate year volume of operations. “Second level certification”: Referral Center for Abdominal Wall Surgery. It is a public or private structure run by at least two already certified and confirmed FLC surgeons. “Third level certification”: High Specialization Center for Abdominal Wall Surgery. It is a public or private structure, already confirmed as Referral Centers, run by at least three surgeons (two certified and confirmed with FLC and one research fellow in abdominal wall surgery). Both levels of certification have to meet the Surgical Requirements and facilities criteria fixed by the Commission. Conclusion: The creation of different types of Hernia Centers is directed to create two different entities offering the same surgical quality with separate mission: the Referral Center being more dedicated to clinical and surgical activity and High Specialization Centers being more directed to scientific tasks

ERNIE INGUINO-CRURALI : ANATOMIA E CLASSIFICAZIONE

Nella riparazione delle ernie inguino-crurali, le tecniche protesiche, introdotte negli anni \u201990 hanno determinato una semplificazione nell\u2019esecuzione della procedura chirurgica rendendo meno stringente la necessit\ue0 di isolare le varie strutture muscolo-aponeurotiche. Tuttavia la genesi delle ernie della regione inguino-crurale, la loro corretta classificazione e la loro riparazione, indipendentemente dall\u2019accesso utilizzato, sono strettamente correlate all\u2019anatomia di questa regione. Gli autori descrivono dettagliatamente le strutture anatomiche coinvolte e le varie classificazioni proposte negli ultimi 40 anni basate su dati anatomici, fisiopatologici o chirurgici. I vari sistemi classificativi proposti risultano per\uf2 il pi\uf9 delle volte difficili da ricordare per l\u2019estrema esasperazione del dettaglio, poco intuitivi e dipendenti dal tipo di accesso chirurgico effettuato. In conclusione sembra che il sistema di classificazione oggi pi\uf9 utilizzato sia ancora quello concepito quasi 200 anni fa che identifica le ernie in indirette, dirette e femorali. Proprio in quest\u2019ottica semplificativa, appare assai valida la classificazione proposta dalla European Hernia Society nel 2004, nella quale le ernie vengono suddivise in primitive e ricorrenti, viene mantenuta l\u2019identificazione del difetto erniario (ernie mediali, laterali e femorali) e la misurazione della porta erniaria ha come riferimento il dito indice dell\u2019operatore