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Clinical guidelines are evidence-based recommendations developed by healthcare organizations or expert panels to assist healthcare providers and patients in making appropriate and reliable decisions regarding specific health conditions, aiming to enhance the quality of healthcare by promoting best practices, reducing variations in care, and at the same time, allowing tailored clinical decision-making. European Hernia Society (EHS) guidelines aim to provide surgeons a reliable set of answers to their pertinent clinical questions and a tool to base their activity as experts in the management of abdominal wall defects. The traditional approach to guideline production is based on gathering key opinion leader in a particular field, to address a number of key questions, appraising papers, presenting evidence and produce final recommendations based on the literature and consensus. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method offers a transparent and structured process for developing and presenting evidence summaries and for carrying out the steps involved in developing recommendations. Its main strength lies in guiding complex judgments that balance the need for simplicity with the requirement for complete and transparent consideration of all important issues. EHS guidelines are of overall good quality but the application of GRADE method, began with EHS guidelines on open abdomen, and the increasing adherence to the process, has greatly improved the reliability of our guidelines. Currently, the need to application of this methodology and the creation of stable and dedicated group of researchers interested in following GRADE in the production of guidelines has been outlined in the literature. Considering that the production of clinical guidelines is a complex process, this paper aim to highlights the primary features of guideline production, GRADE methodology, the challenges associated with their adoption in the field of hernia surgery and the project of the EHS to establish a stable guidelines committee to provide technical and methodological support in update of previously published guideline or the creation of new ones.

Background: Abdominal wall surgery (AWS) is characterised by the increasing caseload and the complexity of the surgical procedures. The introduction of a tailored approach to AWS utilising laparoendoscopic, robotic and/or open techniques requires the surgeon to master several surgical techniques. All of which have an associated learning curve, and the necessary knowledge/experience to know which operation is the right one for the individual patient. However, the reality in general surgery training shows that training in just a limited number of procedures is not enough. By the end of general surgery training, many chief residents do not feel they are yet ready to carry out surgery independently. Therefore, hernia surgery experts and societies have called for the introduction of a Fellowship in Abdominal Wall Surgery.Methods: The UEMS (Union Européenne des Médecins Spécialistes, European Union of Medical Specialists) in collaboration with the European Hernia Society (EHS) introduced a fellowship by examination in 2019. As a prerequisite, candidates must complete further training of at least 2 years with a special focus on abdominal wall surgery after having completed their training in general surgery. To be eligible for the examination, candidates must provide evidence of having performed 300 hernia procedures. In addition, candidates must have accrued sufficient “knowledge points” by attending abdominal wall surgery congresses, courses and clinical visitations, and engaged in scientific activities. On meeting the requirements, a candidate may be admitted to the written and oral examination.Results: To date, three examinations have been held on the occasion of the Annual Congress of the European Hernia Society in Copenhagen (2021), Manchester (2022) and Barcelona (2023). Having met the requirements, 48 surgeons passed the written and oral examination and were awarded the Fellow European Board of Surgery—Abdominal Wall Surgery certificate. During this time period, a further 25 surgeons applied to sit the examination but did not fulfil all the criteria to be eligible for the examination. Fifty experienced abdominal wall surgeons applied to become an Honorary Fellow European Board of Surgery—Abdominal Wall Surgery. Fourty eight were successful in their application.Conclusion: The Fellowship of the European Board of Surgery - Abdominal Wall Surgery by examination has been successfully introduced at European level by the joint work of the UEMS and the EHS. The examination is also open to surgeons who work outside the European area, if they can fulfil the eligibility criteria.

Introduction: Of the more than 20 million patients undergoing groin hernia repair annually worldwide, 6% are scrotal hernias in high resource countries rising to 67% in low resource countries which represents a heavy disease burden on relatively young men during their most productive period of life. There are many open questions concerning management of scrotal hernia. These guidelines aim to improve the care for scrotal hernia patients by reducing recurrence rates, chronic pain and infection.Methods: After developing 19 key questions a systematic literature review was performed till 31 March 2021 for all relevant publications with search terms related to Scrotal Hernia. The articles were scored by all co-authors according to Oxford, SIGN and Grade methodologies. Statements and recommendations were formulated. Online Consensus meetings with 25 HerniaSurge members were organised with voting and grading Recommendations as “strong” (recommendations) or “weak” (suggestions) and by consensus, in some cases upgraded.Results: Only 23 articles (two level 2 registry and 21 level 3–5) were selected. It is proposed to define scrotal hernia as an inguinal hernia which has descended into and causes any scrotal distortion. A new classification for scrotal hernias was proposed based on hernia size, SI for upper third thigh, SII for middle thigh and SIII for lower third thigh or below. Irreducibility is denoted with IR. Despite weak evidence antibiotic prophylaxis is recommended. Urinary catheterization is recommended (upgraded) in complex cases (S2-3) due to prolonged operative time. Scrotal hernia repairs have higher associated morbidity and mortality compared to non-complex groin hernia repairs irrespective of surgical experience. Open anterior (mesh) approach is commonest technique and suture techniques in low resource countries. For minimally invasive approaches, TAPP resulted in less conversion to open approach compared to TEP.Conclusion: Although the evidence is scarce and often low quality scrotal hernia management guidelines aim to lead to better surgical outcomes irrespective of where patients live. This necessarily means a more tailored approach based on available resources and appropriate skills. The guidelines provide an impetus for future research where adoption of proposed classification will enable more meaningful comparison of different techniques for different hernia sizes.

Background: Robot assisted laparoscopic abdominal wall surgery (RAWS) has seen a rapid adoption in recent years. The safe introduction of the robot platform in the treatment of abdominal wall hernias is important to safeguard the patient from harm during the learning curve. The scope of this paper is to describe the current European training curriculum in RAWS.Methods and Analysis: The pathway to competence in RAWS will depend on the robot platform, experience in other abdominal procedures (novice to expert) and experience in the abdominal wall repair techniques. An overview of the learning curve effect in the initial case series of several early adopters in RAWS was reviewed. In European centres, current training for surgeons wanting to adopt RAWS is managed by the specific technology-based training organized by the company providing the robot. It consists of four phases where phases I and II are preclinical, while phases III and IV focus on the introduction of the robotic platform into surgical practice.Conclusion: On behalf of the Robotic Surgery Task Force of the European Hernia Society (EHS) we believe that the EHS should play an important role in the clinical phases III and IV training. Courses organized in collaboration with the robot provider on relevant surgical anatomy of the abdominal wall and procedural steps in complex abdominal wall reconstruction like transversus abdominis release are essential. Whereas the robot provider should be responsible for the preclinical phases I and II to gain familiarity in the specific robot platform.

The paper discusses the emancipatory potential of Uruguayan Vocational Educational and Training (VET) practices, usually associated with job discourses, skills and training. In doing so, we revisit Rancière’s work concerning intellectual emancipation to provide us with a guide to connect with the phenomena studied, as a lens to look at and to problematize emancipation in concrete practices on a heuristic level. Thus, the paper is structured as follows. First, we describe the context of Uruguayan VET practices. Second, we discuss Rancière’s key concepts about emancipation in education. Third, we craft a conversation between the empirical and theoretical work, in view of exploring concrete VET practices from the axiom of equality. Last, the text concludes with a reflection on new meanings regarding Rancière’s intellectual emancipation that deserve further attention and allow us to identify other forms of emancipatory potential in VET practices, to move beyond its currently predominant functionalist understanding.

This paper has as central argument that the recently emerging sociomaterial approach to education has an inherently critical potential, but that this capacity is not yet fully deployed and explored in educational studies. In order to make this argument, this paper starts, first, with a concise description of representationalist versus relational thinking, and argues that sociomaterial studies have to be situated in the latter current. Consequently, the role of critique that is largely upheld in representationalist thinking –that is, a role primarily directed at debunking and unveiling– needs to be rethought. In order to reconceive this role, the paper secondly elaborates upon the key characteristics of sociomaterial studies in education in order to show such relational thinking takes shape in and during the conduct of sociomaterial research. These characteristics are crucial in order to fully apprehend the critical prospect of sociomaterial approaches in education. The role of critique, then, amounts to an engaged attitude vis-à-vis the practices under investigation, and more particularly points to critical creativity as offering some horizons of change.

El propósito de este artículo es reconsiderar las concepciones de educacionalización y gramática escolar (cf. Depaepe, 2005) a la luz de la excesiva importancia atribuida al aprendizaje en la actualidad. Además, queremos señalar que conceptos como poder disciplinario y panoptismo ya no son adecuados para comprender lo que se denomina sociedades de aprendizaje y ambientes de aprendizaje. El concepto de dispositivo de aprendizaje se sugiere como concepto alternativo para abordar estas cuestiones y tal vez como puntos de partida para (futuros) análisis centrados en la gramática del aprendizaje.

The particular relationship between a teacher and his/her subject is the focus of this article. It reports on an analysis of the way in which this relationship is conceptualized in educational research. Four thematic fields emerged from the review,i.e., teachers’ beliefs on, knowledge of, emotions on, and commitment to the subject. Within each thematic field we described major findings regarding the way in which the relation between the teacher and the subject taught is described in educational research. Based on the review, we stress the need for research that takes not only seriously the cognitive, but also the affective relationship of the teacher with its subject.