М. М. Польман • Б. ван ден Хувель • Я. Д. Дилдер • Г. С. А. Абис • Н. Бедекер • Р. Р. Битнер • Дж. Кампанелли • Д. ван Дам • Б. Я. Дварс • Х. Х. Экер • А. Фингерхат • И. Хатков • Ф. Кекерлинг • Дж. Ф. Куклета • М



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Обсуждение
Консенсус, который мы определяем как согласие между, по меньшей мере, 75% участников конференции по разработке совместного заключения, был достигнут для трех четвертей (36 из 48) утверждений. Пять из 36 утверждений, в отношении которых был достигнут консенсус, были поддержаны данными с уровнем достоверности доказательств 1, и 21 утверждение основывалось на доказательствах с уровнем достоверности 5, что указывает на нехватку доказательств высокого уровня достоверности в сфере эндоскопической герниопластики паховых грыж. Интересно отметить, что консенсус был достигнут для 63% утверждений уровня 1 (5 из 8) и для 84 % (21 из 25) утверждений уровня 5. Очевидно, что утверждения с высоким уровнем доказательности не обязательно связаны с уверенным консенсусом в хирургическом сообществе, и наоборот.

Существующие рекомендации, опубликованные Европейским обществом герниологов (EHS) и Международной ассоциацией эндоскопической герниологии (IEHS), составлены на основании анализа литературы небольшой группой экспертов, при этом члены указанных организаций формально не внесли никакого вклада. Несколько ученых-хирургов из EHS и IEHS были включены в экспертную комиссию конференции по разработке совместного заключения EAES, для обеспечения платформы, состоящей из представителей всех организаций, специализирующихся на хирургии паховых грыж. Сочетание медицинских данных с мнениями экспертов и членов хирургического сообщества обеспечивает уникальный метод разработки наилучших практических рекомендаций.

Ограничением данного исследования является вовлечение менее 10% (из ~2 700) членов EAES. Для повышения степени вовлечения членов EAES утверждения конференции по разработке совместного заключения были опубликованы на веб-сайте EAES за 4 недели до встречи в Брюсселе. Помимо этого протокол прошедшей конференции по разработке согласованного заключения был опубликован на веб-сайте EAES после окончания встречи, вместе с цифровым модулем голосования, который позволял принять участие в голосовании членам организации, которые не смогли посетить конференцию. Несмотря на небольшое количество членов, которые использовали эту возможность, использование цифровых методов коммуникации заслуживает дополнительного внимания в качестве способа участия для тех, кто не может посещать конференции лично.

В итоге более трех четвертей хирургов, принявших участие в конференции по выработке консенсуса во время конгресса EAES в 2012 году, достигли согласия по трем четвертям из 48 утверждений, касающихся эндоскопической герниопластики паховых грыж. Сотрудничество между всеми организациями, которые специализируются на лечении паховых грыж, такими как EAES, EHS и IEHS, научные исследования высокого качества (т.е. рандомизированные контролируемые испытания и реестры), посвященные паховым грыжам, а также учет мнений и опыта хирургического сообщества представляют собой элементы обеспечения дальнейшего улучшения качества медицинской помощи пациентам с паховыми грыжами.


Заявление о финансовой незаинтересованности: М. Польман, Б. ван ден Хувель, Я. Д. Дилдер, Г. Абис, Н. Бедекер, Р. Битнер, Дж. Кампанелли, Д. Дам, Б. Дварс, Х. Екер, А. Фингерхат, И. Хатков, Ф. Кекерлинг, Дж. Куклета, М. Мизерез, А. Монтгомери, Р. М. Муноз Брандс, С. Моралес Конде, Ф. Е. Майсомс, М. Солтес, В. Тромп, Я. Явуз и Х. Я. Боньер не имеют конфликтов интересов или финансовых связей, подлежащих раскрытию.

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