ACHQC Quality Improvement Summit

  • The goal of ACHQC Quality Improvement Summit is to create a different kind of meeting for practicing surgeons, industry partners, and the ACHQC team to improve the quality of care we deliver to our patients.
  • This focused meeting is centered around high-quality information obtained by ACHQC surgeons and their clinical teams about hernia and abdominal surgery patients and their experiences for quality improvement purposes.
  • We learn lessons from high performing surgeons and surgical teams to improve the quality of care for the collaborative as a whole. This collaborative approach to quality improvement can transform healthcare in a very real way.
  • After the QI Summit, surgeons are expected to take away at least 3 things that can be used to improve the quality of care delivered to their patients back home.
  • Surgeons participating in the ACHQC and the Quality Improvement Summit represent a unique type of practitioner who is dedicated to continually improving the quality of care delivered to their patients and to patients across the country with similar problems.

Save the Date! 2027 ACHQC Quality Improvement Summit

We invite you to join us for the 9th Annual ACHQC Quality Improvement Summit! The meeting is a true collaborative learning experience where we analyze data, identify high performers and share critical quality improvement in patient data to maximize your outcomes. It will be highly interactive and critical to our quality improvement mission.

Dates: April 16-18, 2027

Location: Hyatt Centric Chicago Magnificent Mile (633 N St Clair St, Chicago, IL 60611)

 

Highlights from the 2026 ACHQC Quality Improvement Summit

2026 QI Summit Meeting Program

 

Session 1: A Patient-First Approach

  • Nancy Ly presented research examining the relationship between socioeconomic status and healthcare resource utilization. She also shared qualitative data exploring patient experiences when denied surgical care due to preoperative optimization requirements. Her work highlighted patients’ lived experiences, their willingness to accept risk, and the significant quality-of-life burden associated with incisional hernias. She was the recipient of the 2025 ACHQC Research Grant Award.
  • Courtney Collins emphasized the importance of continuously reassessing patient-reported outcomes (PRO) tools to ensure we measure what truly matters to patients. She highlighted the value of incorporating Decision Regret into routine PRO collection and discussed refinement of the HerQLes instrument.
  • David Anderson offered a powerful patient perspective, describing his navigation of the healthcare system and eventual care under Kaela Blake at UT Knoxville. This presentation strongly reinforced our patient-first mission.

Presentations:

Session 2: Optimizing Outcomes in Hernia Repair

  • Nancy Ly presented a study comparing barrier-coated versus non-coated mesh in CDC Class II and III wounds, reporting no significant differences in wound-related outcomes or mesh infection rates. Further clinical trials are needed to clarify long-term safety and efficacy.
  • Sergio Mazzola demonstrated the significant impact of anxiety and depression on both clinical and patient-perceived outcomes following hernia repair, emphasizing the importance of preoperative mental health optimization.
  • Erika Schmidt challenged historical reporting of inguinal hernia repair volumes in the United States, noting database limitations and lack of clarity regarding prosthetic mesh usage.
  • Ali Alipouriani presented data evaluating environmental exposure and its association with ventral hernia outcomes.
  • W. Taylor Head presented early findings from a randomized controlled trial assessing abdominal core rehabilitation and physical therapy, suggesting meaningful functional improvements in larger defects.

Presentations:

Session 3: Breakout Sessions

  • Mazen Al-Mansour led discussion on improving PRO measurement in foregut surgery and coordinating a multi-society task force with SAGES and the American Foregut Society to develop and validate a hiatal hernia–specific PRO tool.
  • Megan Melland Smith discussed with the ACHQC leadership focused on bridging gaps in patient expectations and perceived risk tolerance, developing standardized care pathway guidelines, and expanding hernia-focused educational resources for trainees.
  • The ACHQC plans to formalize an Educational Committee and enhance registry tracking of trainee participation levels.

Session 4: Learning from the Experts

  • Lucas Beffa reviewed technical aspects of open retromuscular Key-Baker repair in ileal conduit parastomal hernias, emphasizing safe dissection and mesh positioning.
  • André Brandalise presented advanced techniques for complex and redo paraesophageal hernia repairs, focusing on mediastinal dissection, esophageal mobilization, crural closure, and fundoplication strategy.
  • Sam Zolin discussed flank hernia repair strategy, including positioning, retroperitoneal dissection, incision planning, and appropriate indications for minimally invasive approaches.

Presentations:

Session 5: Billing

  • Krishay Sridalla evaluated the 2023 coding changes, noting a modest increase in wRVU credit for academic surgeons due to case complexity and minimal change for non-academic surgeons.
  • Flavio Malcher shared practical experience navigating updated coding terminology, prompting collaborative discussion regarding optimization while maintaining compliance.

Presentations:

Session 6: HERnias Collaborative

  • Charlotte Horne outlined the mission and vision of the HERnia Alliance and the importance of female-specific hernia outcomes research.
  • Sarah Budney reviewed guideline adherence for inguinal hernia repair in women, noting strong alignment with MIS recommendations and discussion regarding Shouldice repair considerations for assessing the femoral space.
  • Alisa Khomutova demonstrated gender differences in patient-reported outcomes and emphasized the need to measure cosmesis in ventral hernia repair. Plans were discussed to incorporate EuraHS into ventral modules.
  • Josephine Fuller presented data highlighting high rates of anxiety and depression in women undergoing ventral hernia repair and stressed the importance of preoperative mental health screening.
  • W. Taylor Head presented outcomes related to division versus preservation of the round ligament, noting lower long-term pain rates when divided.

Presentations:

Session 7: Maximizing Data Entry into the Oberd Platform

  • Clayton Petro discussed the benefits of EMR integration with Oberd and reported significant reduction in data-entry burden after implementation.
  • Jeremy Warren presented PRISMA’s early experience integrating wearable technology to assess outcomes in frail hernia patients.
  • Andrea Wood provided a preview of Oberd Version 2, highlighting improvements in data-entry efficiency and patient interface design.

Presentations:

Session 8: Inguinal Hernia Data-Driven Outcomes

  • Marguerite Mainprize from the Shouldice Clinic in Toronto shared their research infrastructure and institutional outcomes, with potential interest in joining ACHQC.
  • Courtney Collins presented preliminary data identifying patient factors associated with limited quality-of-life improvement after ventral hernia repair.
  • Ayesha Siddiq compared anatomic versus flat mesh in inguinal repair, noting slightly reduced operative time with anatomic mesh but no significant differences in wound complications, recurrence, or quality-of-life outcomes.

Presentations:

Session 9: Committee Breakout

  • Members of the ACHQC Quality Improvement Committee outlined ongoing initiatives and plans for international registry collaboration.
  • The Patient Engagement & Advocacy Committee emphasized closing communication gaps between surgeons and patients regarding expectations for hernia surgery.

Session 10: Overview of the QC and Maximizing Engagement

  • Megan Melland-Smith challenged surgeons to reconsider rigid comorbidity cutoffs that may exacerbate healthcare disparities in symptomatic incisional hernia patients.
  • Aldo Fafaj shared candid reflections on integrating ACHQC participation into early surgical practice, emphasizing leadership persistence and academic rewards.
  • Noah Tocci presented results from the NO OPIOIDS embedded registry study, demonstrating higher refill rates in the zero-opioid group and outlining the need for further subgroup analysis.

Presentations:

Session 11: Technical Considerations in Inguinal Hernia Surgery

  • Sergio Mazzola presented data on defect closure techniques during robotic inguinal hernia repair and recommended refinement of registry variables.
  • Wes Love shared technical pearls for optimizing MIS inguinal repair and effective teaching strategies.
  • David Krpata outlined six key principles for managing chronic groin pain, including patient selection, expectation setting, multidisciplinary care, and structured mesh removal.

Presentations:

Session 12: Getting to the Core of the Problem

  • Randall Zhou discussed sports performance optimization and its relationship to hernia outcomes.
  • William Bennett presented 5–6 year outcomes comparing medium-weight versus heavyweight mesh, noting concerning fracture rates in medium-weight mesh during large open TAR repairs.
  • Joe Edwards concluded with extensive experience managing urinary conduit parastomal hernias, demonstrating safe and effective use of synthetic mesh in both keyhole and Sugarbaker techniques.

Presentations:

 

Highlights from the 2025 ACHQC Quality Improvement Summit

2025 QI Summit Meeting Program

 

Session 1: Setting the Stage for Optimum Outcomes: Preoperative Optimization

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Session 2: Mentoring Future Surgeons: How Can We Optimize Post-Graduate Hernia Training?

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Session 3: Measuring What Matters: Inguinal Hernias

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Session 4: Improving Outcomes Through Mastery: Routine Hernias

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Session 5: Group Breakout Session

  • Group 1 - What is the Role for Heavyweight Mesh, and What Do We Need From Industry?
  • Group 2 - What Outcomes Should We Be Measuring, and Should We Change?
  • Group 3 - Prophylaxis
  • Group 4 - Parastomal Hernias: What Does the Data Say We Should Be Doing?

Session 6: Innovative Techniques to Navigate Challenges: How to Get Out of Trouble

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Session 7: Mountains of Opportunity: Expanding Networks for Quality Improvement in Abdominal Core Health

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Session 8: Practice Management: Billing & Coding

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Session 9: Research & RCTs

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Session 10: Foregut

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Highlights from the 2024 ACHQC Quality Improvement Summit

2024 QI Summit Meeting Program

 

Session 1: A Decade of Data - What Have We Learned from 10 years in the ACHQC?

This session reviewed 3 Key aspects of ventral hernia repair using data from the ACHQC.

  • Mazen Al-Mansour, MBBS carefully evaluated the literature supporting much of the discussion around preoperative optimization and made a case that while preoperative optimization is helpful and should be considered in most cases, having hard cutoffs can unnecessarily delay surgical care for many patients—particularly those at highest risk for health care disparities.
  • Clayton Petro, MD argued that the heavy emphasis on extraperitoneal mesh, particularly for smaller, less complex defects, might be overstated and many surgeons have not considered the potential downsides related to complications associated with the often advanced reconstructive techniques to get mesh outside of the peritoneal cavity.  
  • Jeremy Warren, MD provided several unique pain management strategies to help reduce pain and improve postoperative recovery in patients undergoing hernia repairs.  

Presentations: 

Session 2: ELEVATING INGUINAL HERNIA OUTCOMES

This session focused on improving outcomes for inguinal hernia repairs utilizing data from the ACHQC.

  • Jonathan Yunis, MD, one of the busiest and most productive surgeons in the ACHQC, shared his experience as a solo private practice surgeon. He detailed how he incorporates the data from the ACHQC on his outcomes and integrates that into the day-to-day care of his patients. He presented his algorithm to help determine when to apply open, robotic, and laparoscopic techniques to inguinal hernia repairs.  
  • Katherine Cordero Bermudez, MD presented one centers algorithm to repair multiple scenarios of inguinal and ventral hernias using MIS and open techniques.
  • Megan Melland-Smith, MD presented her experience while working at the Shouldice Clinic in Toronto.  She detailed much of the rationale behind the success of the hospital from why the floors are carpeted to eating meals with fellow patients.  She also detailed several of the important technical elements of a Shouldice inguinal hernia repair.
  • Kimberly Woo, MD reported the long-term outcomes of permanent versus absorbable fixation for inguinal hernia repair utilizing tacks.  Ultimately there was no significant difference between the absorbable and permanent tacks with regards to pain or clinical outcomes.

Presentations: 

SESSION 3:  FIRESIDE CHAT WITH OUR HIGH PERFORMERS – INGUINAL HERNIA OUTCOMES VIDEO LEARNING

This session was focused on video-based learning from high performers in the field of inguinal hernia repairs.  One of the most unique features of the ACHQC is that we can identify high performers based on volumes and or clinical outcomes. In each of our video-based sessions, we featured top performers to offer technical insights for other members of the collaborative to optimize their outcomes.

  • Rana Higgins, MD shared her approach to inguinal hernia repairs while performing a robotic TAPP. With particular emphasis on accessing the correct plane and exposing key elements of the myopectinal orifice.  
  • Michael (Micki) Reinhorn, MD, MBA detailed the technical aspects of exposure and dissection of a Shouldice inguinal hernia repair.
  • Nora Fullington, MD made a compelling argument that the open preperitoneal inguinal hernia repair offered several of the advantages of MIS and open approaches.  Allowing access to the retroperitoneal space for mesh placement akin to the MIS repairs, while allowing open access above the groin and away from the nerves.
  • Todd Harris, MD shared his approach to TEP hernia repairs while working as a high-volume private practice surgeon in an ambulatory surgery center without access to robotic platforms.
  • Alan Kravitz, MD gave his first lecture at a national meeting and offered a wealth of relevant information including the history behind the Lichtenstein  hernia repair as well as some of the practical and necessary benefits of performing these open outpatient procedures for many patients who simply can not afford some of our more expensive approaches to repair inguinal hernias.  He also shared his experience with performing these procedures while on medical/surgical mission trips and the rewards of giving back.

Presentations:

SESSION 4: TAKING A PANORAMIC VIEW - HEALTH CARE DISPARITIES IN HERNIA SURGERY

This session has remained a highlight of the ACHQC QI Summit.  Utilizing several of our health care determinants and unique tools such as the distressed communities index, we can probe into the challenges of overcoming health care inequities in hernia surgery.

  • Arielle Perez, MD, MPH, MS gave an informative overview of several of the health care inequities that are facing minorities in our current health care environment. These included less access to MIS approaches, more emergency repairs, and highlighted the potential for preoperative optimization to disproportionately affect minorities and underserved populations.  
  • Francesco Palazzo, MD showed that female patient reported outcomes for inguinal hernia repairs tended to be worse than males.  He offered several future avenues for expanded research to try and further characterize these differences.
  • Maha Mourad, DO linked early postoperative complications to the socioeconomic distress level of patients undergoing inguinal hernia repair.  She offered a solution to identify these patients potentially preoperatively at highest risk and offer modifiable alternatives to decrease their risks of suffering a postoperative complication.

Presentations:

SESSION 5: REALISTIC EXPECTATIONS - WHERE ARE WE WITH PREHABILITATION?

One of the themes of the QI Summit was trying to strike the balance between being too dogmatic in our need for hard cutoffs with regards to attempts at preoperative optimization, while understanding that helping patients optimize their health has the potential to have a lifelong impact on their quality of life. 

  • Joshua Trussell, MD started the session off with a review of what he offers in his practice.  He also compelled the QC to continue to evaluate what potential optimization strategies offers the best chance at both short- and long-term success after hernia repairs.
  • Sara Maskal, MD presented data from a single institution showing that there was not a major impact on marijuana use and outcomes for complex abdominal wall reconstruction. Interestingly, the only major signal identified was an association with increased perioperative pain, which may be of benefit for surgeons to tailor post operative pain management based on cannabis use status. 
  • Luis Arias-Espinosa, MD linked the 5 item Frailty test using standardized QC data to outcomes.  This could be another option to identifying high risk patients most suitable for hernia repair.

Presentations:

SESSION 6:  NAVIGATING THE COURSE - A PRACTICAL GUIDE TO WHAT I DO

This was another session focusing on high performers offering technical advice on how to improve outcomes in ventral hernia repairs.

  • Charlotte Horne, MD shared with the members her approach to open complex abdominal wall reconstruction with myofascial advancement flaps and how to reduce wound morbidity.
  • Bryan Ellis, DO detailed his personal algorithm to repair all sizes of umbilical hernias. He presented a thoughtful approach of when to perform open, with and without mesh and when an MIS approach both lap and robotic makes the most sense.
  • Rana Higgins, MD presented her indications and approach to performing robotic IPOM hernia repairs for small to medium sized ventral hernias.  She focused on tips and tricks for port placement, fascial closure techniques, and mesh fixation. 
  • Anthony Iacco, MD reported his single center approach to traumatic flank hernia repairs with particular attention to patient positioning, dissection plane and mesh location. 

Presentations:

SESSION 7: MASTERING THE MOUNTAIN OF OPTIONS - WHAT DO WE NEED TO KNOW ABOUT MESH TYPE AND LOCATION TO GET THE BEST OUTCOMES?

At the end of a busy and packed agenda on the first day, we discussed the impact of mesh type and location on outcomes and some of the needed data for future analysis to really answer this vexing question.

  • McKell Quattrone, MD reported the QC experience with different mesh weights for parastomal hernia repairs. Most of the mesh selected was light weight and medium weight.  There were a few heavy weight meshes utilized as well. The short- and long-term differences between mesh weight were minimal and not significant.  
  • Phillip Cox, MD evaluated the minimal amount of overlap necessary for long term success in ventral hernia repair. He found that despite routinely closing the fascia, there was a direct correlation between the amount of overlap and the risk of recurrence. While no discreet cutoff could be established he suggests that the surgeon should balance the risk of causing harm by increasing overlap to the potential for future recurrences.
  • Benjamin Poulose, MD, MPH presented provocative data analyzing the mesh tissue interface and the potential alterations in genetic sequencing.  This data was admittedly preliminary and should be interpreted with caution, but there were some oncologic genes that had upticks in expression.  More work is underway in this compelling investigation. 
  • Kimberly Woo, MD performed one of the first analysis that linked CMS long term reoperation for recurrence data to ACHQC clinical data.  This analysis evaluated the outcomes of retromuscular versus intraperitoneal mesh.  This marks a huge milestone for the ACHQC as we venture into a world with significantly more opportunity for evaluating long term outcomes of our prosthetic devices and surgical techniques.

Presentations:

SESSION 8: MANEUVERING AMIDST MOGULS - STRATEGIES FOR RISK REDUCTION

This session evaluated complication prevention strategies for complex abdominal wall reconstruction.

  • Mazen Al-Mansour, MBBS presented data on the rates of thromboembolic events in the ACHQC and various mitigation strategies. He noted that it was a relatively uncommon event occurring in less than 1% of cases but was most strongly associated with the size of the hernia defect.
  • Megan Melland-Smith, MD shared a high-volume single center experience on efforts to optimize postoperative pain management in complex AWR and how the potential for removing epidurals might have led to a significant increase in the risk of ileus.  
  • Xavier Pereira, MD identified several key factors of complexity that are associated with increased risk of mortality for those patients undergoing complex abdominal wall reconstruction. Much of this data can be used for shared decision making and informed consent for patients undergoing these complex reconstructions. 

Presentations:

SESSION 9: DOUBLE BACK TERRAIN - COMPLEX AWR

  • Winnie Henderson, MD, PhD shared with the collaborative her practice as a breast and AWR surgeon and how she has incorporated the ACHQC into her day-to-day life.  She also impressed upon the collaborative how much resources are available for the patients on the ACHQC app and how using it has improved her outcomes and patient satisfication.
  • Fareed Chemma, MD reported the early experience of the ACHQC on a novel approach called SCOLA.  Highlights included the importance of proper patient selection based on the skin and soft tissue component of their diastasis. 
  • Prashanth Sreeramoju, MD looked at the 9-year trends of ventral hernia repairs performed at the ACHQC.  Several important findings included the growth of robotics, the continued utilization of IPOM approaches, and the increase in fascial closure rates.  
  • Justin Leavitt, MDcompared a well-matched group of patients undergoing simultaneous panniculectomy to those not.  He did not note any long-term advantage, but also did not identify an increased rate of wound complications in those undergoing panniculectomy. 
  • Flavio Malcher, MD, MSc evaluated a common surgical problem of concomitant procedures and their affect on outcomes in hernia repairs.  He specifically sought to address the situation of simultaneous GYN procedures. He did not note any significant association of negative outcomes with these two procedures being performed simultaneously.  He also cautioned that this data is retrospective, and some selection bias my confound this data. 
  • Caprice Greenberg, MD, MPH updated the collaborative on the exciting preliminary results of our ongoing trial on coaching to reduce complications after ventral hernia repairs.  

Presentations:

SESSION 10: AWR TECHNICAL TALKS

Another session on high performers sharing key operative strategies to improving outcomes in challenging situations.

  • Clayton Petro, MD shared his algorithm for repairing flank hernias.  He focused on interpreting the preoperative CT scan to guide patient positioning, incision location, MIS/Open approach, and mesh location.  
  • Abhishek Parmar, MD reported his early experience with performing robotic flank hernia repairs.  He offered several key technical aspects including patient selection, optimization, and appropriate plane for mesh deployment.
  • Jeremy Warren, MD gave the collaborative several important considerations for reducing complications during contaminated abdominal wall reconstruction.  He reported the results of his embedded RINSE trial showing that antibiotic irrigation didn’t have a significant affect on reducing wound morbidity.  He also outlined several hernia and patient features that would allow for simultaneous reconstruction during a contaminated case.

Presentations:

SESSION 11: UPDATES ON EMBEDDED REGISTRY STUDIES

With the ongoing work of the ACHQC to leverage the acquisition of high-quality data during the routine care of patients, several embedded RCTS have come to fruition.  

  • Sara Maskal, MD presented her trial comparing patients who were exposed to self-selected music during general anesthesia versus no music. She found no difference in recovery, pain, or anxiety between the two groups.
  • Clayton Petro, MD reported the 2-year outcomes of a randomized controlled trial comparing the retromuscular Sugarbaker versus keyhole mesh configurations with synthetic mesh for 150 parastomal hernia patients.  The Sugarbaker approach was not superior to the keyhole repair based on 2 year radiographic recurrence rates.  
  • Jeremy Warren, MD shared the long-term outcomes of the ORREO trial comparing the short- and long-term outcomes of robotic versus open retromuscular hernia repairs in high risk patients.  He found that the robotic approach was not superior to the open approach with regards to wound morbidity, and hernia recurrence.  As a secondary outcome, there was a 1-day difference in length of stay favoring the robotic approach.
  • Ryan Ellis, MD presented the long-term outcomes of a randomized controlled trial comparing anterior gastropexy versus no anterior gastropexy in 240 patients undergoing minimally invasive paraesophageal hernia repairs.  He found that the anterior gastropexy significantly reduced long term radiographic hernia recurrence rates and suggests that it should be routinely performed in these procedures. 
  • Sara Maskal, MD presented preliminary findings from her randomized controlled trial comparing the long-term outcomes of suture repair versus mesh repair with posterior sheath release and 4:1 closure in hernias less than 6 cm in width. Sara won the ACHQC Resident & Fellow Research grant for her work in this trial, and we anxiously await the long-term outcomes at the completion of the trial.

Presentations:

SESSION 12: RECOVERY OPTIMIZATION - ENHANCING POSTOPERATIVE QUALITY OF LIFE OUTCOMES

The ACHQC has continued to advance in providing the highest quality data to help improve outcomes and recovery for patients. This session focuses on identifying key aspects of individual ERAS programs and opportunities for improvement. 

  • Clayton Petro continued the work of the Opioid reduction taskforce as they evaluated the opioid prescribing patterns for outpatient ventral hernia repair. They again linked consumption to the number of opioids prescribed.  They suggested a cutoff of 10 tablets of opioids for most outpatient ventral hernia repairs.
  • Benjamin Poulose, MD gave a glimpse into the future of patient reported outcomes collection. He linked the incorporation of wearable devices and the quality-of-life data that they collect to provide a means for real time collection of patient reported outcomes.  He also described how this data could be incorporated into our data collection platform.
  • Daphne Remulla, MD reported a project underway by the Quality Improvement committee of the ACHQC.  The group has identified several key components to a functional ERAS program for AWR.  As they compile the data, they plan to offer a summarized ACHQC endorsed ERAS program.
  • Andy Yang, MD, PhD, MBA thoroughly evaluated the effect of smoking on wound outcomes of ventral hernia repair. He performed an in-depth analysis and identified the granular aspects of smoking, and whether the history of smoking plays a role in wound morbidity.  

Presentations:

Session 13: 10,000 FT Lookout - Financial Outlook for Ventral Hernia Repair

The conference was concluded by two provocative looks at how the new coding changes are affecting the coding of ventral hernia repairs.​

  • Mazen Al-Mansour, MBBS evaluated the finanical effects of these coding changes in his own practice. He did not notice a major change in RVUs or dollars. However, he acknowledged that this data represents just his practice and may not be relevant to other physicians with different hernia practices.
  • Christopher Schneider, MD carefully analyzed the reporting of the hernia width both before the changes in billing and afterwards. He identified a small increase in reporting of hernias over 3 centimeters in width but readily acknowledged that more data is needed. That analysis will be performed and hopefully addressed next year.

Presentations:

Highlights from the 2023 ACHQC Quality Improvement Summit

2023 QI Summit Meeting Program

 

Session 1: Complex Situations in Hernia Repair - Part 1

  • Investigators confirm synthetic mesh is safe in contaminated fields and corroborate several recent RCTs, but also identify that surgical technique might be the most important driving factor of these outcomes.
  • Medium weight polypropylene mesh fractures were identified in 4% of a large series of open retromuscular mesh hernia repairs. Investigators suggest utilizing heavy weight PP mesh for routine clean open retromuscular surgery.
  • Patients have a 4% lifetime risk of requiring another abdominal surgery after complex abdominal wall reconstruction and consideration should be given preoperatively to rule out common causes of needing further abdominal surgery.
  • A single center evaluated the outcomes of open clean retromuscular surgery after lifting stringent smoking restrictions and did not find a significant change in wound morbidity rates calling into question the role of preoperative smoking cessation as being mandatory.

Presentations:

Session 2: Health Care Disparities and Preop Optimization

  • Methocarbamol was found to significantly improve postoperative pain control when added to standard ERAS pain control pathway.
  • Associations were determined that linked surgeon and patient sex concordance with clinical outcomes.
  • The impact of distressed communities from rural and urban centers were evaluated based on common hernia outcomes.

Presentations:

Session 4: Para Impossible Hernias: Will we ever be able to actually fix these? - Parastomal & Paraesophageal Hernia Repair

  • Synthetic, absorbable synthetic and biologic mesh was compared for open onlay parastomal hernia repair with overall fairly similar short term outcomes.
  • Patients with mesh placement during repair of parastomal hernias in patients with inflammatory bowel disease did well in the short term.
  • The role of placement of mesh during stoma takedown was critically evaluated and the ultimate choice to stage the repair or perform in a single setting was debated.
  • Robotic, laparoscopic and other controversies were reviewed in a robust panel of paraesophageal hernia experts.

Presentations:

Session 5: Updates on Embedded Randomized Controlled Studies

  • An ongoing randomized controlled trial evaluating robotic versus open TARs (ROVHR) trial was discussed for hernias 7-15cm in width.
  • The long term outcomes of the REVEAL trial comparing robotic ETEP versus IPOM were reported showing a slight advantage for robotic IPOM with regards to abdominal wall function.
  • The 90 day outcomes of a randomized controlled trial evaluating Open retromuscular synthetic mesh based parastomal hernias in a Keyhole versus Sugarbaker configuration reported similar results with a slightly higher rate of mesh related reoperations in the Sugarbaker group.  Long term follow up is ongoing.

Presentations:

Session 6: Inguinal Hernia Repair

  • There was no link to laterality of hernia repair and outcomes in the ACHQC. 
  • Active smoking was not linked to worse outcomes for MIS inguinal hernia repair again calling into question the requirements of smoking cessation for elective inguinal hernia repair. 

Presentations:

SESSION 7: Breakouts

  • Attendees broke out into three groups to discuss the following topics:
    • Research & Collaboration: Designing and Executing the Next Embedded RCT
    • Increasing Patient Engagement Through Videos and Active Means
    • Getting the Most Out of the QC in Community and Private Practice: Tips and Tricks on How to Incorporate the QC Workflow for Data Entry and How I Market Myself Using the QC

Presentation:

Session 8: ACHQC Resident & Fellow Research Grant

Presentation: 

Session 9: Complex Situations in Hernia Repair - Part 2

  • Excellent outcomes with the use of barbed sutures for ventral hernia repair were reported. 
  • A slight reduction in wound morbidity was found in patients undergoing robotic versus open retromuscular hernia repairs. 
  • A thorough review of core muscle injuries and their surgical outcomes in the ACHQC were reported.   These procedures are rarely performed in the QC and might suggest a high utilization of physical therapy and surgery as a last resort.  
  • Surgeon’s ability to determine the type of prior abdominal wall reconstruction through CT image review was shown to be highly inaccurate and unreliable.

Presentations:

Session 10: Outcomes for Robotic Surgery and Other Hernia Repairs

  • The routine placement of drains was shown to reduce seromas in robotic retromuscular hernia repairs. 
  • Outcomes of obese patients undergoing robotic and open repairs were assessed and found to be relatively comparable.
  • The utilization of TAR and robotic retromuscular hernia surgery was shown to be increasing in the ACHQC.
  • The use of virtual visits were shows to reduce carbon emissions significantly and could be a huge contributor to environmental stewardship.

Presentations:

Session 12: How I Do It: Prophylaxis  

  • Data and techniques to provide midline fascial reinforcement during high risk closures was discussed.
  • Outcomes of reinforcing new stomas and during stoma takedowns with mesh was discussed with a focus on the technical aspects of each approach.

Presentations:

  • Mesh for Midline Incisional Hernias - William Hope, MD
  • Mesh for Reinforcement of Creating Stoma - Wes Love, MD
  • Mesh Reinforcement for Stoma Takedowns - Jeremy Warren, MD

 

 

2022 QI Summit Meeting Program

 

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2019 QI Summit Meeting Program

 

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