Department of Surgery, Shouldice Hospital, 7750 Bayview Avenue, Thornhill, ON, L3T 7N2, Canada.
Department of Surgery, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada.
Hernia. 2023 Feb;27(1):147-156. doi: 10.1007/s10029-022-02658-y. Epub 2022 Aug 8.
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.
疝修补术是一种常见的外科手术，之前已经有很多关于 Shouldice 腹股沟疝修补术的研究描述了其结果。然而，本文的目的是了解 Shouldice 医院的专家认为 Shouldice 方法的关键步骤是什么。
利用 Delphi 方法，被认为是内容专家的 Shouldice 医院的外科医生对什么是 Shouldice 方法的关键步骤提供了他们的答案。从这些回答中确定了中位数、四分位距和百分比一致性，以及 Delphi 的整体 Cronbach's Alpha。所有 Delphi 项目都在五点李克特量表上进行排名，当 Cronbach's Alpha ≥ 0.8 时达到共识。调查中的项目，如果在五点李克特量表上有≥80%的参与者完全同意或部分同意（5-完全同意或 4-部分同意），则被纳入最终框架。
最终的 Shouldice 方法共识包括 39 个项目，分为 7 个总体步骤：患者术前准备、麻醉成分、切口和神经识别、提睾肌处理、疝识别和治疗、后墙重建和患者术后管理。
这项共识的结果为 Shouldice 方法提供了一个逐步的方法，以及及时的信息，可供将非网片疝修补术纳入其实践的外科医生使用。
