PDF(Pubmed)
Abstract：
Background: Growing evidence on the use of mesh as a prophylactic measure to prevent parastomal hernia and advances in guideline development methods prompted an update of a previous guideline on parastomal hernia prevention. Objective: To develop evidence-based, trustworthy recommendations, informed by an interdisciplinary panel of stakeholders. Methods: We updated a previous systematic review on the use of a prophylactic mesh for end colostomy, and we synthesized evidence using pairwise meta-analysis. A European panel of surgeons, stoma care nurses, and patients developed an evidence-to-decision framework in line with GRADE and Guidelines International Network standards, moderated by a certified guideline methodologist. The framework considered benefits and harms, the certainty of the evidence, patients\' preferences and values, cost and resources considerations, acceptability, equity and feasibility. Results: The certainty of the evidence was moderate for parastomal hernia and low for major morbidity, surgery for parastomal hernia, and quality of life. There was unanimous consensus among panel members for a conditional recommendation for the use of a prophylactic mesh in patients with an end colostomy and fair life expectancy, and a strong recommendation for the use of a prophylactic mesh in patients at high risk to develop a parastomal hernia. Conclusion: This rapid guideline provides evidence-informed, interdisciplinary recommendations on the use of prophylactic mesh in patients with an end colostomy. Further, it identifies research gaps, and discusses implications for stakeholders, including overcoming barriers to implementation and specific considerations regarding validity.
摘要：
背景：越来越多的证据表明使用网片作为预防造口旁疝的预防措施，以及指南开发方法的进步促使更新了先前的造口旁疝预防指南。目标：制定基于证据的，值得信赖的建议，由跨学科的利益相关者小组提供信息。方法：我们更新了先前关于使用预防性网片进行结肠造口术的系统评价，我们使用成对荟萃分析合成了证据。一个欧洲外科医生小组,造口护理护士，患者根据GRADE和指南国际网络标准制定了一个证据决策框架，由认证的指导方法学家主持。该框架考虑了利弊，证据的确定性,患者的偏好和价值观，成本和资源考虑，可接受性,公平性和可行性。结果：造口旁疝的证据确定性中等，主要发病率低，造口旁疝的手术,和生活质量。小组成员一致认为，有条件地建议在结肠造口术和预期寿命公平的患者中使用预防性网状物。并强烈建议在发生造口旁疝的高风险患者中使用预防性网片。结论：该快速指南提供了证据，关于在结肠造口患者中使用预防性网状物的跨学科建议。Further,它确定了研究差距，并讨论了对利益相关者的影响，包括克服实施障碍和关于有效性的具体考虑。
