背景:疝修补术是一种常用的外科手术,腹股沟疝的Shouldice修补术在其结果方面已经得到了很好的描述。然而,本文的目的是了解Shouldice医院的专家认为Shouldice方法的基本步骤。
方法:利用德尔菲方法论,Shouldice医院的外科医生被认为是内容专家,提供了他们对Shouldice方法至关重要的答案。中位数,四分位数间距,确定了答复的百分比一致性以及Delphi的Cronbach的整体Alpha。所有Delphi项目均按5点Likert量表进行排名,当Cronbach'sAlpha≥0.8时达成共识。在5点李克特量表上,≥80%的参与者中排名为5-完全同意或4-部分同意的调查项目被纳入最终框架。
结果:Shouldice方法的最终共识包括39个项目和7个总体步骤:患者的术前准备,麻醉成分,切口和神经识别,对炼乳肌肉的治疗,疝气的识别和治疗,后壁的重建,以及患者的术后管理。
结论:该共识的结果为Shouldice方法提供了逐步的方法,以及及时的信息,可以被外科医生利用,将非网状疝修补术纳入他们的实践。
Hernia repairs are a commonly performed surgical procedure and the Shouldice Repair of inguinal hernias has been well described before in terms of its outcomes. However, the purpose of this paper was to understand what experts from Shouldice Hospital consider to be the essential steps to the Shouldice Method.
Utilizing a Delphi Methodology, surgeons at Shouldice Hospital who are considered content experts, provided their answers on what is essential to the Shouldice Method. The median, interquartile range, and percent agreement from the responses as well as the Delphi\'s overall Cronbach\'s Alpha were determined. All Delphi items were ranked on a five-point Likert scale and
consensus was reached when Cronbach\'s Alpha was ≥ 0.8. The items from the survey that ranked as 5-completely agree or 4-partially agree by ≥ 80% of participants on the five-point Likert scale were included in the final framework.
The final
consensus for the Shouldice Method included 39 items with 7 overarching steps: preoperative preparation of the patient, anesthetic component, incision and nerve identification, treatment of the cremasteric muscles, hernia identification and treatment, reconstruction of the posterior wall, and post-operative management of patients.
The results of this
consensus provide a step-by-step approach to the Shouldice Method, as well as information that is timely and can be utilized by surgeons incorporating non-mesh hernia repairs into their practice.