Introduction

Introducing ANZ Hernia

Hernia is a common and major health issue in Australia and New Zealand.Over60,000 patients have hernia surgery annually at a cost of over $350 million dollars. 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.

Currently, hernia surgery is undergoing substantial change. Many new techniques and technologies are being introduced, including advanced AWR (Abdominal Wall Reconstruction) procedures, robotics and new prostheses. These new methods require evaluation. There is also substantial variance in hernia repair with more than 100surgical techniques and over 150 approved meshes available and little or no data to guide decision making.

Given the increased media exposure and legal proceedings arising from uro-gynaecological mesh implants, patients are concerned about the use of mesh in hernia repair. This highlights the low quality of evidence available on safety, effectiveness and morbidity of meshes, and raises concerns about governance and post-insertion surveillance. The result – a significant loss in consumer confidence. Consequently, the TGA has recently reclassified mesh in line with EU recommendations to Class III, mandating strict criteria prior to registration of mesh for human use and a rigorous process to monitor post insertion surveillance.

Several attempts at forming a dedicated hernia craft group within Australia have largely been still born. A meeting in Perisher in 2011 under the auspices of the Australasian Hernia Society did not eventuate in a wider acceptance of this group as a leader in hernia surgery within Australia. A paper suggesting the establishment of a subspecialty group, delivered at the hernia meeting in Adelaide in March 2015did not garner much support from the attendees.

Never the less a few surgeons from that meeting have continued to work away on a more formal structure to advance the practice of hernia surgery in Australia.

Recently established, ANZ Hernia co-hosted the Adelaide Hernia meeting in 2019 along with the very successful ANZAWR 2020 and ANZAWR 2021 virtual meetings held in conjunction with the AWR Surgeons group from India. At the 2021 RACS ASC a formal presentation was delivered introducing ANZ Hernia and the way forward to promulgate, oversee and monitor hernia surgery in Australia.

Endorsed by the RACS and with the support of surgeons from both countries ANZ Hernia aims to foster improved education and training and both clinical and basic science research. It 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 reimburse mentto reflect the time and effort involved in complex procedures. Importantly it will also oversee the ANZ Hernia Clinical Quality Registry to track hernia and mesh outcomes in Australia and New Zealand.

By engaging with government and consumers, ANZ Hernia will endeavour to restore consumer confidence in mesh mediated hernia repair.

We are inviting all general surgeons to be involved in ANZ Hernia and the ANZ Hernia Quality Registry as it is developed and rolled out.