[Medicine should be evidence-based, surgery too].
SURGERY TOO: The concept of evidence-based medicine, in vogue for several years, must also apply to surgery, even if the latter has specific characteristics. ADVANTAGES OF EVIDENCE-BASED SURGERY: The advantages are related to the expansion of surgeons' critical eye and their questioning of the scientifically unfounded dogmas. CONSTRAINTS OF EVIDENCE-BASED SURGERY: The constraints are not only basically material with the need to have access to data banks, which often costs money, but also methodological with the need to assess the scientific quality of the articles found in the literature. LIMITS OF EVIDENCE-BASED SURGERY: These are related to the rarity of randomized trials and meta-analyses in the surgical literature and therefore, regarding surgery as opposed to other medical domains, to the reduced level of evidence. Hence,to develop good quality, so-called "pragmatic" and prospective trials is needed. DANGERS OF EVIDENCE-BASED SURGERY: The greatest danger is the fact that the evidence-based approach is either misunderstood or misconstrued, particularly since it integrates in the scientific data the surgeons' decision, the clinical context or even the patients' preference.


CONCLUSIONS
Evidence-based surgery is not a fleeting fancy. Today, it is a well-established fact, the aim of which is to treat the patients according to the most fitting scientific data.
Slim
Karem
K
Service de Chirurgie Générale et Digestive, Hôtel-Dieu, Clermont-Ferrand.
D019992:Databases as Topic; D019317:Evidence-Based Medicine; D013502:General Surgery; D006801:Humans; D015201:Meta-Analysis as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic