Page 95 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Table 1. Using the GRADE approach to guideline development(22) the Quality of the body of evidence is rated (high/moderate/low/very low) and the recommendations are graded as strong or weak
Grading the Quality of the body of evidence for each Key Questions using the GRADE approach
Underlying methodology
Randomized trials;
or double-upgraded observational studies.
Downgraded randomized trials; or upgraded observational studies.
Double-downgraded randomized trials; or observational studies.
Triple-downgraded randomized trials; or downgraded observational studies; or case series/case reports.
Quality rating Symbols
High ■■■■ Moderate ■■■□
Low ■■□□ Very low ■□□□
De nitions
Further research is very unlikely to change our con dence in the estimate of e ect
Further research is likely to have an important impact on our con dence in the estimate of e ect and may change the estimate
Further research is very likely to have an important impact on our con dence in the estimate of e ect and is likely to change the estimate
Any estimate of e ect is very uncertain.
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EHS guidelines
Strong recommendation Weak recommendation
No recommendation
Based on the available evidence, if clinicians are very certain that bene ts do, or do not, outweigh risks and burdens they will make a strong recommendation.
Based on the available evidence, if clinicians believe that bene ts and risks and burdens are nely balanced, or appreciable uncertainty exists about the magnitude of bene ts and risks, they must o er a weak recommendation.
If based on the lit
Grading of recommendations using the GRADE approach
Which diagnostic modality is the most suitable to detect incisional hernias?
No systematic reviews on diagnostic modalities for incisional hernias were found. Fifteen records were included in the qualitative analysis(1-3, 6, 50-60). Only four studies were retained as High Quality and are listed in the Summary of Findings table (Table 2)(3, 50, 51, 60).
The quality of most studies investigating the diagnostic accuracy of imaging techniques was low to very low. Only some provided a sensitivity analysis. Because no studies compared di erent diagnostic modalities in a similar methodology and with similar study arms, no pooling of data was useful or possible. In general, most studies show that medical imaging will increase the rate of detection of incisional hernias compared to physical examination. In an everyday clinical setting this is usually not important, because most asymptomatic hernias do not require treatment and their diagnosis is thus not necessary.
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