Adapting national to international guidelines and back – an example on groin hernia guidelines




Poster session 3 Friday: Evidence Tools / Evidence synthesis - creation, publication and updating in the digital age


Friday 15 September 2017 - 12:30 to 14:00


All authors in correct order:

Van Enst A1, van den Heuvel B2
1 Knowledge Institute for Medical Specialists, the Netherlands
2 Jeroen Bosch Ziekenhuis, the Netherlands
Presenting author and contact person

Presenting author:

Annefloor Van Enst

Contact person:

Abstract text
Background: In 2002, the Dutch Society of Surgery took initiative to develop Dutch guidelines on inguinal hernia. Carrying on the success of these guidelines, the European Hernia Society invited the Dutch chair to develop guidelines in European context. A working group representing 14 countries published European Hernia Society guidelines of inguinal hernia in adult patients in 2009. Last year, the guidelines were updated and adapted to a global perspective, resulting in the publication of World Guidelines for Groin Hernia Management (WHO, 2016). This year we will adapt the world guidelines for Dutch use. A joined effort will be made by the Dutch Society of Surgery, Cochrane Netherlands, and the Knowledge Centre of Medical Specialists.

Objectives: To identify barriers and facilitators for updating and adapting guidelines in several perspectives.

Methods: Guidelines on inguinal hernia have been updated and adapted to different perspectives (Dutch, European and global). The latest adaptation has started this year. Experiences from the chairs, working group members and methodologists are collected in a quantitative manner.

Results: Adapting guidelines on inguinal hernia from a national to an international perspective and back seems to be efficient. Clear and full reporting of methods and results is essential in this process to produce good-quality guidelines. For example, having access to declarations on conflicts of interest of the working group, search strategies, GRADE profiles and evidence to decision frameworks is needed to adapt and update a guideline. Clinicians and methodologists participating in both international and national working groups facilitates the adaptation process even further. One should avoid leaving publication rights to a commercial organisation, as it may obstruct re-use of evidence syntheses.

Conclusions: Developing guidelines that are suitable for adaptation should be aimed with more guidelines. This can lower costs spend on guidelines development, leaving room to address more topics and/ or update guidelines more frequently. The European Hernia Society and the Dutch Society of Surgery have set a good example.