Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie (SICE); Associazione Chirurghi Ospedalieri Italiani (ACOI); Società Italiana di Chirurgia (SIC); Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT); Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP); and the European Association for Endoscopic Surgery (EAES)
by Ferdinando Agresta, MD, Board Member - Italian Society of Endoscopic Surgery
On the behalf of the members of the panel and the societies involved in the Consensus
More than five years have passed since the EAES published guidelines on emergency laparoscopy (Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc. 2006;20(1):14-29. Epub 2005 Oct 24). In January 2010, the SICE Scientific and Educational Committee, affiliated with the EAES, had the idea to revisit the clinical recommendations for the role of laparoscopy in adult abdominal emergencies with the intent being to update the EAES indications and to supplement the existing guidelines on specific diseases.
In order to better analyze the existing “evidence” on the subject, other Italian Surgical Societies [ACOI, The Italian Society of Hospital Surgeons; SIC, The Italian Society of Surgery; SICUT, The Italian Society of Trauma and Emergency Surgery; and SICOP, The Italian Private Hospitals’ Surgical Society] were invited to join SICE in choosing a panel of 12 experts in laparoscopic and open emergency surgery. The involved scientific societies represented the entire Italian surgical community, but only surgeons!!
As this was a consensus statement, we invited others including radiologists (SIRM, Italian Society of Radiology); anesthesiologists (SIAARTI, Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care); gynecologists (SIGO, Italian Society of Gynecology and Obstetrics), epidemiologists; nurses (IPASVI, Italian National Federation Nursing Council); health-services researchers; hospital administrators (Federsanità, Italian Federation of Local Health Districts and Municipalities); health managers (SIMM, Italian Hospital Managers Society); and Health Care Regulators (ISS, The Italian National Health Institute). A patient’s association was also invited and participated (Cittadinanzattiva Active Citizenship).
In November 2010, all members of the panel met in Rome for 2 days to discuss each chapter according to the Delphi method, producing a key statement with a grade of recommendations followed by commentary explaining the rationale and evidence behind the statement. Key statements were formulated according to a 100% consensus obtained within the group. These statements were presented June 2011 at the EAES Annual Congress in Turin, and the draft was published on the websites of all the involved Italian surgical societies for two months. The manuscript has been revised by Prof. Fingerhut and Uraneus and by Prof. Garattini for the methodology.
It has been an enormous but interesting work: two years in order to achieve the goal…and we want to share this experience with all the colleagues involved in laparoscopy and above all emergency laparoscopy at the Italian National Guidelines System <http://www.snlg-iss.it/cms/files/CC_laparoscopia_addome.pdf>.
This millennium is the one of globalization, in which we share experience, speak the same language, and grow up together to offer the best chance of cure to our patients.
Every surgeon has generally developed a fine ability to decide the best approach according to a personal evaluation of her/his own experience and proficiency, the clinical situation, the experience of the team, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data to support her/his judgment.