Q&A with Dr. Michael Rosen: New Hernia Center Director

Says field is ‘ripe for improving outcomes’

Earlier this month, Michael J. Rosen, MD, FACS, stepped into his new role as Director of Cleveland Clinic’s Hernia Center, the first comprehensive center of its type in Northeast Ohio and only one of a handful of such centers across the country.

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In a recent Q&A with eDigest, Dr. Rosen revealed why he’s passionate about hernia surgery and how he’s innovating every day. He explained what the focus of his new role will be and shared details about the clinical work and research he’s doing to advance the field and improve patient outcomes.

He will be working closely with other surgical and clinical specialists within the Digestive Disease Institute (DDI) and across the health system to leverage and grow their collective expertise in minimally invasive, complex open and repeat surgeries — including complex abdominal wall reconstruction.

A national leader in the field, Dr. Rosen most recently served as Chief of General Surgery and Professor of Surgery at University Hospitals Case Medical Center in Cleveland with a focus on comprehensive hernia repair. He conducted research at Cleveland Clinic during his residency, and during the past three years, he has been collaborating with biomechanical engineers at Cleveland Clinic’s Lerner Research Institute to develop innovative surgical materials.

Q: Can you tell us more about your new role at Cleveland Clinic and why it’s a good fit for you?

As Director of the Digestive Disease Institute’s Hernia Center, my vision and strategic plan are focused on a team approach to providing the best care possible for patients with all types of hernias. Cleveland Clinic is an exciting place to be focused on this specialty area, not only because of its world-class care, but also because of the breadth of patients seen here — from the main campus to the community hospitals to the ambulatory care centers.

I can’t think of any disease process besides hernias that has such a significant impact throughout the enterprise, and the collaborative, multidisciplinary approach to care at Cleveland Clinic is the ideal environment for achieving optimal patient outcomes.

Q: What are your top priorities?

A: My priorities can be broken into three parts: clinical excellence and innovation, research,and education:

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  • Clinical excellence and innovation: We see a wide spectrum of cases at our Hernia Center — from inguinal hernias that can be repaired laparoscopically on an outpatient basis, to incisional hernias with a one to two day length of stay, to ventral hernias that can be repaired with minimally invasive techniques if done right the first time.

We also specialize in complex open and repeat surgeries — including complex abdominal wall reconstruction — which are referred to us from all over the country and the world. We are able to do successful repairs on patients who have lost almost their entire abdominal wall due to trauma or infection, tumor resection or multiple failed past hernia repairs. We sometimes see patients who have already had 20 to 30 operations to try to fix a problem.

  • Research: The work I have been doing the past few years with bioengineers from Cleveland Clinic’s Lerner Research Institute is in conjunction with Cleveland Clinic Innovations, the commercialization arm of Cleveland Clinic. The projects are focused primarily on innovative mesh and other materials to repair hernias. Currently, we are in the process of submitting a grant application to develop a new hybrid mesh to improve outcomes in complex abdominal wall reconstructions.

In both research and clinical work, I feel that it’s very important to measure the patient’s functional outcomes. For example, I’ve done studies following abdominal wall repair that use sit-up machines to measure the force that can be generated after bringing the patient’s abdominal muscles back together. This type of tracking is rarely done in the field of hernia repair, but it’s important to evaluate and measure changes in the patient’s long-term quality of life.

  • Education: One of the reasons I am so excited about joining Cleveland Clinic is that it’s an excellent platform to educate other surgeons around the world about hernia repair, including sharing newer techniques and information that can improve outcomes.

Q: Can you talk about your focus on innovation and collaboration, especially as related to complex cases such as abdominal wall reconstruction?

I have developed several surgical techniques that we will be employing here, including newer minimally invasive approaches, novel ways to approach complex abdominal wall reconstructions to avoid problems with raising skin flaps, and resections with complex and challenging defects.These improvements have translated into better patient outcomes. For example, the new approaches to complex abdominal wall reconstruction have reduced both post-operative infections and wound complications by more than 50 percent.

Successful abdominal wall reconstruction hinges on multidisciplinary collaboration. At our Hernia Center, some of the specialists that may be involved in a complex case include general surgeons with a special interest in hernia repair, plastic surgeons for some of the more complicated reconstruction and cosmetic aspects, colorectal surgeons for complex GI issues that can occur in these patients, and sometimes bariatric surgeons, because obesity is a common problem in this patient population. We also have close working relationships with smoking cessation and nutrition experts to optimize patients’ health prior to surgery.

Q: Why are you passionate about hernia repair?

A: When hernia surgery goes wrong, it results in some of the most despondent, challenged patients with the worst quality of life who are desperate for improvements. This is hard to imagine, because hernia surgery is probably the most common surgery performed by general surgeons, with an estimated 750,000 to 1 million cases done each year in the United States. However, hernia disease has been one of the most neglected procedures in the field of general surgery. There has been very little innovation for patients with hernias during the past 50 years.

When I became involved with this specialty 10 years ago, I made it my professional goal to employ a scientific and translational approach to improving patient outcomes and identifying better surgical materials. The field of hernia surgery is ripe for improving outcomes. 

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Q: You’re involved on a national level as a leader in this field; can you tell us more?

 A: I am medical director of the Americas Hernia Society Quality Collaborative (AHSQC), which brings surgeons from across the United States together to collaborate, share data, and improve the value in hernia care delivered to patients. Formed in 2013 by hernia surgeons in private practice and academic settings, the AHSQC utilizes concepts of continuous quality improvement to improve outcomes and optimize costs.

Q: If you had one area in which you would like to see referrals to the Hernia Center expand, what would it be?

A: I would like to see more referrals at the early end of the spectrum. If we can perform the initial repair, it’s more likely that we can employ minimally invasive techniques and help the patient avoid problems in the future. While we have developed techniques for complex and repeat surgeries that are more successful than ever before, the best chance to get the best outcome is the first time the repair is performed.

For more information, please contact Dr. Rosen at 216.445.3441 or at rosenm@ccf.org.