Was ist evidenzbasiert in der Viszeralchirurgie?

Zusammenfassung

Neben der immanenten Schwierigkeit, die Frage nach evidenz-basierten Inhalten eines so großen Fachgebietes wie der Viszeralchirurgie zu beantworten, ist auch die Aufgabe als solche nicht unproblematisch. Wie bereits dargestellt, sind als verlässliche Quelle höchster Evidenz (Stufe I a) systematische Reviews randomisiert-kontrollierter Studien anzusehen. Viele etablierte Therapieverfahren werden aber heutzutage lediglich durch Meinung, Fallbericht oder retrospektive Auswertung gestützt. Dabei handelt es sich gerade bei der Durchführung von chirurgischer Behandlung oft um sprichwörtlich „einschneidende” und definitive Veränderungen für den Patienten. Sie bedürfte daher besonders dringend der fundierten wissenschaftlichen Evaluation. Im Gebiet der Viszeralchirurgie sind derzeit wegen des Mangels an entsprechenden qualitativ hochwertigen Untersuchungen nur wenige Fragestellungen auch auf evidenz-basierter Grundlage zu beantworten, zum anderen lassen vorliegende Reviews kaum unmissverständliche Schlussfolgerungen für das tägliche Handeln zu. Wie auch die Mehrzahl der systematischen MetaSanalysen muss diese Betrachtung mit der Bemerkung schließen, dass in den nächsten Jahren weitere randomisierte und kontrollierte Studien erforderlich sind, um dem Viszeralchirurgen zusätzlich zu seiner persönlichen Expertise konkrete evidenz-basierte Handlungsanleitungen zur optimalen Therapie seiner zahlreichen Patienten zu geben.

Abstract

Beside the immanent difficulty to answer the question for evidence-based contents of such a large domain as the visceral surgery, the task itself is also not unproblematic. As already shown, the systematic reviews of randomised-controlled studies are to be considered as reliable sources of highest evidence. Many established therapy-methods are nowadays merely supported by opinion, case-study or retrospective analysis. Especially with the realisation of surgical therapy it is mostly the matter of proverbially “incisive” and definitive changes for the patient. Therefore this urgently would require the particularly substantiated scientific evaluation. Because of the deficiency of high-quality examinations in the domain of visceral surgery, only a few questions can be answered on evidence-based principles at present; on the other hand present reviews hardly permit unambiguous conclusions for the daily handling. Like the majority of systematic meta-analysis, this approach has to close with the remark that in the next years more randomised and controlled studies are necessary, in order to give a visceral surgeon, in addition to his individual expertise, concrete evidence-based instructions for action in the optimum therapy of his numerous patients.

Evidenzbasiert - Viszeralchirurgie

Evidence-based - visceral surgery

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