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Why I became a hernia surgeon

Authors: Andrew de Beaux, MD, MBChB, FRCSEd, FEBS, AWS

NHS Lothian, Scotland,
Oxford University Hospitals, England
Spire Murrayfield Hospital, Scotland

Andrew de Beaux, MD, MBChB, FRCSEd, FEBS, AWS

It is interesting how surgery evolves. What was largely seen as a training operation left to trainees, hernia repair become a rapidly expanding area of surgery now linked under the more prestigious title of Abdominal Wall Surgery.  And it is also interesting to see how careers evolve. In my own case, while always having an interest in hernia surgery, chance events, from whom I worked with, who I met in industry and the opportunities to change surgical interests because of colleagues, should not be underestimated. Once I started talking about incisional hernia repair, the referrals came flooding in! Looking back on my career, I give the 5 reasons, that in retrospect, moulded my career as an Abdominal Wall surgeon.

1. Friends in the hernia business worldwide.

Much of my training and early Consultant career was in oesophago-gastric cancer surgery – but I eventually saw the light! And the rest is history. Becoming a hernia surgeon was interesting – announcing the fact at scientific conferences you could see the surgeons who were members of the cool and awesome surgical specialities feeling sorry for me, that I was not even good enough to be a breast surgeon! But I gladly left them behind, joining and collaborating with a group of hernia surgeons around the world. The opportunity to work with others, and travel the world, with a human, friendly bunch of people has been a privilege and an honour for me.

2. Hernias keep you humble!

    I have alluded to this already, but hernia surgery has been the orphan subspecialty of general surgery, with no official home such as colorectal and the like. Even my dear old mum when asked what sort of surgery her son did, said “its hernia – but he does big ones you know!” (Figure 1) The UEMS now recognises abdominal wall surgery as a subspecialty, with the ability to sit an examination to become a Fellow of the European Board of Surgery Abdominal Wall Section (FEBS AWS).

    Figure 1. Before and after umbilical (primary ventral) hernia repair. The lady had been told by many surgeons over the years previously that her hernia was inoperable, and surgery would likely kill her! But as the hernia increased in size, her quality of life disappeared.

    3. Still a lot to learn!

    We are in an era of rapid accumulation in hernia knowledge. Little over thirty years ago, a limited number of open non-mesh repairs were the toolbox of the general surgeon tackling hernias. It has been exciting to be part of this hernia revolution, describing pseudo-recurrence in intraperitoneal onlay mesh repair (IPOM), the peritoneal or hernia sac flap repair, the partial preperitoneal pocket (PPPP) repair for lateral hernias, and the mesh:defect ratio concept rather than simple one size fits all mesh overlap margin. Collaboration, from basic science, clinical studies, education to guidelines remains an exciting learning opportunity for me, and I encourage others to walk the same path. 

    4. We make a difference!

    Cancer surgery often saves lives, but often at a cost from the resectional surgery. Elective hernia surgery is benign surgery; it’s quality of life surgery; it’s often a form of cosmetic surgery – but we should remember the outcome is important for the patient (Figure 2). I receive more thank you letters from abdominal wall patients in their follow-up than I ever did in a busy cancer service. And ‘thank yous’ keep us going, particularly when a case has not gone well, as they sometimes do as you take on the more complex hernia repairs.

    Figure 2. Before and after incisional hernia repair – multiple laparotomies for Crohn’s disease surgery. Abdominal wall repair aims to improve core stability and abdominal wall function while also trying to improve the external cosmetic appearance.

    5. Remember/research our forefathers.

    Not everyone has an interest in history I know, but I have enjoyed researching those who went before, and it gives me a sense of where we stand in history. Now is not the time to mention them all, but the words of William Halstead (1853-1922) still ring true today, “Surgery could deliver no better a gift for mankind than a perfectly safe cure for hernia”. We still have some way to goes in this regard. And closer to home, the words of Sir William Heneage Ogilvie (1887-1971) “I know more than 100 surgeons whom I would cheerfully allow to remove my gallbladder but only one to whom I would expose my inguinal canal.”

    Hernia surgery, abdominal wall reconstruction, rates low on the cool and awesome scale in surgery. But the rewards are high in every way. I encourage you too to become a hernia hero and shero!


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