Transferable Competency Adominal Wall Surgery Ferdinand Köckerling MD Professor of Surgery Chairman Department of Surgery and Centre of Minimally Invasive Surgery Certified Centre of Obesity Surgery Certified Centre of Hernia Surgery Academic Teaching Hospital of Charité Medical School Vivantes Hospital Berlin

New Transferable Competency “The trend towards greater specialization is supported by the European Board of Surgery” “The Surgical Scientific Societies are encouraged to develop other new Board denominations” Wolfgang Feil President of the European Board of Surgery https://uemssurg.org/general/contact

Do we need the Transferable Competency Abdominal Wall Surgery ? Project of the European Hernia Society (EHS) ACCESS – Accreditation and Certification requirements for Abdominal Wall Surgery Centers and Surgeons F. Köckerling, A.J. Sheen, D. Cuccurullo, D. Kopelman, R. Fortelny, F. Berrevoet, G.Campanelli, H. Friis-Andersen, J.F. Gillion, J. Osterberg, J. Gorjanc, M. Simons, M. Lopez Cano, M. Smietanski, W. Reinpold; ' R.K.J.Simmermacher, S. Morales-Conde, D Weyhe

Do we need the Transferable Competency Abdominal Wall Surgery ? ACCESS – Project of the European Hernia Society (EHS) Statement There is a need for accredited/certified abdominal wall surgery centers and specialists because of the increasing complexity (availabilities of new techniques, an increase in surgical devices and the presence of more complex cases requiring tailored approach) of abdominal wall treatment with an increasing public awareness and expectation in treatment results.

What is the definition of an Abdominal Wall Surgeon ? ACCESS – Project of the European Hernia Society (EHS) Statement A General Surgeon can be trained to become an abdominal wall surgeon by mastering the learning curve of all open and laparo-endoscopic abdominal wall procedures that are recommended in the Guidelines and should additionally implement and fulfill the other requirements for a abdominal wall surgery center and perform a minimal yearly case load

Transferable Competency Abdominal Wall Surgery Knowledge Abdominal Wall Surgery (AWS) is a "transferable competency" which requires the acquisition of "Knowledge" in basic clinical sciences and operative skills as well as specialized "Knowledge and Skills" in the prevention and treatment of all types of abdominal wall defects and covers acute, traumatic and non-acute diseases and injuries.

Transferable Competency Abdominal Wall Surgery Knowledge The “transferable competency” AWS provides the “knowledge and skills” for the non-operative and operative management of all types of abdominal wall defects, i.e. prevention, diagnosis, evaluation, decision making, treatment, intensive care, rehabilitation of patients with pathological processes and acute and chronic pain treatment.

Transferable Competency Abdominal Wall Surgery Knowledge Abdominal Wall Surgery (AWS) cooperates with other surgical and medical specialties, e.g. anesthesia and intensive care medicine, emergency surgery, gastroenterology, general surgery, plastic surgery, internal medicine, radiology, neurology, pediatrics, urology and others in the management of patients.

Transferable Competency Abdominal Wall Surgery Knowlegde and Skills Differentiated use of diagnostic procedures (clinical examination, CT, MRI, Ultrasound) Indication for surgery under consideration of the current guidelines Preoperative conditioning of patients with risk factors (smoking, obesity, pulmonary diseases) Prevention of incisional and parastomal hernias following open abdominal procedures by small-bite suture technique and / or prophylactic mesh Laparo-endoscopic and open treatment of all inguinal hernias in the emergency and elective clinical setting according to the guidelines Surgical skills for inguinal hernia repair according to the guidelines in Lichtenstein, TEP or TAPP and Shouldice techniques

Transferable Competency Abdominal Wall Surgery Knowlegde and Skills Tailored approach in elective inguinal hernia repair under consideration of gender, bi-laterality, recurrence and other factors Laparo-endoscopic and open treatment of all primary ventral hernias (umbilical, epigastric) in the emergency and elective clinical setting under consideration of an additional rectal diastases. Surgical skills in laparoscopic IPOM, open suture, open sublay, open onlay and open component separation techniques for primary ventral hernia repair. Tailored approach in primary ventral hernia repair under consideration of obesity, risk factors, patient status and hernia findings. Laparo-endoscopic and open treatment of all types of incisional hernias (primary, recurrent, medial, lateral, “swiss-cheese”, “loss of domain”) in the emergency and elective clinical setting.

Transferable Competency Abdominal Wall Surgery Knowlegde and Skills Surgical skills in laparoscopic IPOM, open sublay, open IPOM, open onlay and open component separation techniques for incisional hernia repair Tailored approach in incisional hernia repair under consideration of obesity, risk factors, patient status and findings of the hernia Complex ventral and incisional hernia repair in the contaminated surgical field Treatment of diaphragmatic hernias Treatment of mesh infections Techniques for closure of open and burst abdomen Conservative and operative management of all postoperative complications Knowledge about the characteristics of the used medical technology products in hernia surgery (synthetic, biological and biosynthetic meshes, absorbable and non-absorbable tackers, biologic and synthetic glues. Treatment of patients with chronic pain following hernia surgery in cooperation with neurologists and pain experts

Transferable Competency Abdominal Wall Surgery Knowlegde and Skills The focus is on diagnosis and treatment, which comprises all non-instrumental and instrumental techniques including radiology, sonography, computer tomography and magnetic resonance imaging. The AWS must be capable of employing laparo-endoscopic and open techniques for therapeutic purposes and must have the opportunity to gain knowledge and experience in evolving technological methods. The AWS must be also capable of interpreting all types of surgery-related radiological examinations. The AWS surgical activity covers the pre-, peri- and postoperative period including the principles of enhanced recovery and follow-up of patients. The specialty also includes individual and general preventive activities, rehabilitation, and management of pain.