Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Via Pio II n.3, 20153, Milan, Italy.
General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy.
Tech Coloproctol. 2019 Nov;23(11):1037-1056. doi: 10.1007/s10151-019-02099-3. Epub 2019 Oct 12.
Worldwide, stomas represent a medical and social problem. Data from the literature on stoma management are extensive but not homogeneous. In Italy, no guidelines exist for this topic. Thus, clear and comprehensive clinical guidelines based on evidence-based data and best practice are need. In 2018, the Multidisciplinary Italian Study group for STOmas, called MISSTO, was founded. The aim was to elaborate guidelines for practice management of enteral and urinary stomas in adults.
A systematic review of the literature was performed using PubMed, National Guideline Clearinghouse, and other databases. The research included guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation", "stoma creation", "stoma complications", "stoma care", and "stoma reversal". The systematic review was performed for each topic, and studies were evaluated according to the GRADE system, AGREE II tool.
Recommendations were elaborated in the form of statements with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care was held. After discussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines was elaborated and prepared for publication. This manuscript is focused on statements on the surgical management of enteral stomas.
These guidelines are the first Italian guidelines on multidisciplinary management of enteral stomas with the aim of assisting surgeons during stoma management and care.
在全球范围内，造口是一个医学和社会问题。文献中关于造口管理的数据广泛，但并不统一。在意大利，针对这个主题没有指南。因此，需要基于循证数据和最佳实践制定清晰全面的临床指南。2018 年，成立了多学科意大利造口研究组，简称 MISSTO。其目的是制定成人肠造口和尿造口实践管理指南。
使用 PubMed、国家指南清除库和其他数据库进行系统文献回顾。研究包括指南、系统评价、荟萃分析、随机临床试验、队列研究和病例报告。确定了五个主要主题：“造口准备”、“造口创建”、“造口并发症”、“造口护理”和“造口逆转”。对每个主题进行系统评价，并根据 GRADE 系统和 AGREE II 工具评估研究。
以每个声明的推荐等级形式制定了建议。对于科学证据水平较低的声明，举行了一次由意大利主要造口管理和护理科学学会的专家成员组成的共识会议。在专家讨论、纠正、验证或删除声明后，最终版本的指南被制定并准备发表。本文重点介绍肠造口手术管理方面的声明。
这些指南是意大利第一份关于肠造口多学科管理的指南，旨在协助外科医生进行造口管理和护理。
