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"Medicine is continuing to evolve and this is true more so than ever before with a notable direct relation to several possible major factors including substantial changes in the health care systems, progressive scientific advances, an accelerated pace of discovery in biomedical science, heightened public awareness and demands and consequently expectations for transparency and accountability in health care" . "Considering this fundamental, dynamic and rapid evolution, there could also be challenges to and changes in the well-established structure of self-regulating functions involving the medical profession" . "Accrediting and certifying organizations, such as surgical societies, can and should play a major role in ensuring that society will continue to entrust self-governance to the medical profession by directly promoting and supporting consistent excellence in the performance of physicians and health care organizations" .
The medical profession being charged with the remit of self-regulation may well create a relative disbalance with its apparent, albeit responsible, governance presenting difficulties for any laypersons who wish to scrutinize any such self-governed professional body. Good examples of such self-regulation include the governance seen in medical societies, for example, in specialist breast and bariatric centers. The European Society of Breast Cancer Specialists has continued to produce updated and revised guidelines on the requirements of a specialist breast center which are based on the advances and evidence-based changes in contemporaneous clinical practice .
As a consequence, there is now evidence of improved patient outcomes in bariatric surgery centers that have since been accredited/certified according to the requirements of the German Society for General and Visceral Surgery . In a systematic review of the literature, there is clear evidence which demonstrated that accreditation programs will improve clinical outcomes in a wide spectrum of clinical conditions .
Each year some 20 million inguinal hernia operations are performed worldwide with 350,000 and 100,000 ventral hernia operations in the US and Germany, respectively [5, 6].
Hernia surgery has become increasingly more complex over the past 25 years because of the introduction of novel endoscopic, but also open, techniques and of the plethora of medico-technical devices which are now available [5, 6]. Currently though, the lack of standardization for abdominal wall hernia repair has led to the existence of a multitude of techniques and even more options are available for prosthetic mesh selection but with little high-level evidence to suggest the type of technique and mesh to use .
Despite this, numerous evidence-based guidelines published by international hernia societies are endeavoring to keep abreast of these rapid developments [7–18].
However, analyses by hernia registries  demonstrate that the evidence-based guidelines compiled by the international hernia societies are not always implemented .
Although hard evidence that specialist hernia centers perform better than surgeons and/or surgical teams in general practice is scarce, it seems obvious in a subjective analysis in various settings that this mere fact holds some merit. Any subsequent data analysis of these respective centers and their results is compounded by the fact that no clear hernia centers are defined, but it is understood that arbitrary nomenclature is used such as “self-proclaimed” hernia center with so-called hernia specialists. There is therefore a need for accredited/certified hernia centers where hernia surgery is practiced according to the guidelines set by specialist certified hernia surgeons. In addition, these centers will be encouraged with specialization to be coupled with a measurable mastery of hernia surgical techniques as well as playing an active role in training and continuing education in the field of science in hernia surgery .
A credible accreditation/certification process for hernia centers will involve definitions of requirements and their verification by hernia societies that are interested in assuring the best possible quality of hernia surgery .
Examples of such accreditation are the introduction in 2014 of a three-stage accreditation/certification program for hernia centers in Germany conjointly by the German Hernia Society and the German Society of General and Visceral Surgery  and more recently in 2018 the Italian Society of Hernia and Abdominal Wall Surgery which defines the characteristics of accredited/certified hernia centers in Italy .
In September 2017, the European Hernia Society (EHS) commissioned an expert group from across Europe to compile evidence-based requirements for accredited/certified hernia centers. In the absence of any such evidence to date, the goal in this project was to seek an expert, transparent and coherent consensus.