SMA News Digest (Summer 2014): V54, I2 | Page 34

vary, strategies including improving diagnostic expertise
in community based ultrasound and the development of
evidence-based clinical decision rules are realistic goals in
improving diagnosis without the use of CT scan.

6

Avoid repair of minimally symptomatic
inguinal hernias where appropriate by offering an option of watchful waiting for up to
two years.

Repair of minimally symptomatic inguinal hernias in adults
can prevent potentially serious complications due to hernia
incarceration. However, such repairs can also lead to complications such as infection, chronic inguinal pain and hernia recurrence which cumulatively approximate the risks of
incarceration. Evidence shows that such hernias can also be
managed with watchful waiting for up to 2 years after assessment, a choice that should be offered to appropriately
selected persons.

How the list was created

The Canadian Association of General Surgeons (CAGS) established its Choosing Wisely Canada Top 5 recommendations by first having its Clinical Practice Committee review
the American College of Surgeons (ACS) Choosing Wisely®
list. Feeling confident that the American list reflected general surgery issues in Canada (addressing breast cancer diagnostics and treatment, colon cancer screening, trauma diagnostics and screening, admission and preoperative chest
X-rays, and appendicitis diagnostics in children), the CAGS
Clinical Practice Committee approved the list in principle.
The list was then circulated to the CAGS Board and surgeons
that specialized in each area were consulted. Ultimately,
the first five items were adopted with permission from the
Five Things Physicians and Patients Should Question. ©
2013 American College of Surgeons. The CAGS Board also
felt strongly about adding a sixth item to the list about the
treatment of asymptomatic hernia and six items were then
submitted for publication.

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SMA NEWS DIGEST | SUMMER 2014