Without the ability to perform prospective, RCTs, many improvements in health care would not have been achieved. This approach to medical research has led to significant improvements in health care.
#MESHFREE UMBILICAL HERNIA SERGON IN UNITED STATES HOW TO#
This chapter describes the current evidence for the variability of ventral/incisional hernia patients and presents a brief framework for understanding how to apply new thinking to the study of complex problems such as ventral/incisional hernia disease.ĭuring the past 150 years, traditional clinical research methods have been based on reductionist scientific approaches, in which the scientific method is applied to the study of one part or variable (e.g., a drug or device) within a complex system (e.g., a patient’s cycle of care). However, it is incomplete and represents a starting point rather than a goal toward understanding how to improve the value of care for both the patient who presents with a ventral/incisional hernia and the system in which that care is provided. This is not to say that this understanding of EBM does not have value for complex problems, such as abdominal wall hernia disease. This increasing complexity as well as the variability of outcomes leads us to challenge the traditional application of EBM, which to date has not included knowledge generated from clinical quality-improvement studies. In addition, the patient groups presenting with incisional and ventral hernias are becoming more complex as the treatment options, including the varieties of mesh, continue to grow. The application of principles of complex adaptive systems science, particularly real-world clinical quality-improvement methods, likely will be required to improve the value of care (e.g., quality outcomes measures, satisfaction, patient experience, costs) for the patient with a ventral/incisional hernia.Ībdominal wall hernia disease clearly is more complex than previously thought. Part 3 will cover mesh technology, hernia prophylaxis, technique-related issues, new technologic developments, lumbar and other unusual hernias, and training/education.ĭue to the increasing pace of change and the complexity of ventral/incisional hernia patients and techniques, use of traditional human subjects clinical research, evidence-based methods and guidelines in health care should be considered a starting point rather than a goal. The next part (Part 2) of the Guidelines will address complications and comparisons between open and laparoscopic techniques. In this issue of Surgical Endoscopy, the first part of the Guidelines is published including sections on basics, indication for surgery, perioperative management, and key points of technique. The current Guidelines focus on technique and perioperative management of laparoscopic ventral hernia repair and constitute the first comprehensive guidelines on this topic. All guidelines require regular updating, usually every 3 years, in line with progress in the field. However, even experienced surgeons benefit because by virtue of a heavy workload and commitment, they often find it difficult to keep up with the ever-increasing published literature. Guidelines can therefore be valuable in helping particularly the young surgeon in his or her day-to-day work to find the best decision for the patient when confronted with a wide and confusing range of options. According to the results of high-ranking scientific studies published in peer-reviewed journals, statements and recommendations are formulated, and these are graded strictly according to the criteria of evidence-based medicine. They should be developed by an international panel of experts, whereby alongside individual experience, above all, the results of comparative studies are decisive.
Guidelines describe the current best possible standard in diagnostics and therapy. Guidelines are increasingly determining the decision process in day-to-day clinical work.