Clinical guidelines are evidence-based recommendations developed by healthcare organizations or expert panels to assist healthcare providers and patients in making appropriate and reliable decisions regarding specific health conditions, aiming to enhance the quality of healthcare by promoting best practices, reducing variations in care, and at the same time, allowing tailored clinical decision-making. European Hernia Society (EHS) guidelines aim to provide surgeons a reliable set of answers to their pertinent clinical questions and a tool to base their activity as experts in the management of abdominal wall defects. The traditional approach to guideline production is based on gathering key opinion leader in a particular field, to address a number of key questions, appraising papers, presenting evidence and produce final recommendations based on the literature and consensus. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method offers a transparent and structured process for developing and presenting evidence summaries and for carrying out the steps involved in developing recommendations. Its main strength lies in guiding complex judgments that balance the need for simplicity with the requirement for complete and transparent consideration of all important issues. EHS guidelines are of overall good quality but the application of GRADE method, began with EHS guidelines on open abdomen, and the increasing adherence to the process, has greatly improved the reliability of our guidelines. Currently, the need to application of this methodology and the creation of stable and dedicated group of researchers interested in following GRADE in the production of guidelines has been outlined in the literature. Considering that the production of clinical guidelines is a complex process, this paper aim to highlights the primary features of guideline production, GRADE methodology, the challenges associated with their adoption in the field of hernia surgery and the project of the EHS to establish a stable guidelines committee to provide technical and methodological support in update of previously published guideline or the creation of new ones.

3rd Department of Surgery 1st Medical Faculty of Charles University Motol University Hospital Prague Czechia

Abdominal Wall Surgery AZ Maria Middelares Ghent Belgium

Abdominal Wall Surgery Unit University Hospital Vall d'Hebrón Barcelona Universidad Autónoma de Barcelona Barcelona Spain

Amsterdam UMC Department of Surgery University of Amsterdam Amsterdam Netherlands

Department of General and Hepatobiliary Surgery and Liver Transplantation Service University Hospital Medical School Ghent Belgium

Department of Integrated Surgical and Diagnostic Sciences IRCCS Ospedale Policlinico San Martino University of Genoa Genoa Italy

Department of Medicine Surgery and Dentistry University of Salerno Salerno Italy

Department of Surgery OLVG Hospital Amsterdam Amsterdam Netherlands

Department of Surgery Papageorgiou General Hospital Thessaloniki Greece

Hernia Istanbul® Comprehensive Hernia Center Istanbul Türkiye

Spire Murrayfield Hospital Edinburgh United Kingdom

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