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腹腔镜治疗腹疝:意大利国家指南。

Laparoscopic treatment of ventral hernias: the Italian national guidelines.

机构信息

Division of General Surgery, ASL Viterbo, San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy.

Department of Surgical Science, University of Cagliari, Cagliari, Italy.

出版信息

Updates Surg. 2023 Aug;75(5):1305-1336. doi: 10.1007/s13304-023-01534-3. Epub 2023 May 22.

Abstract

Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline's recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline's strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).

摘要

原发性和切口腹疝是一个重大的公共卫生问题,其普遍性、专业实践的多样性以及与治疗相关的高成本都受到了关注。2019 年,意大利内镜外科学会(SICE)董事会根据新的国家规定,推动制定了腹腔镜治疗腹疝的新指南。2022 年,该指南被政府机构接受,并在 SNLG 网站上以意大利语发布。在这里,我们报告所采用的方法和指南的建议,以及其传播政策所确立的内容。本指南是根据 SNGL 指示的方法和应用推荐评估、发展和评估(GRADE)方法制定的。根据 4 个 PICO 问题制定了 15 项建议。其中 12 项建议的推荐级别为有条件,1 项建议为有条件至中度。本指南的优势包括依赖于对文献的广泛系统评价,并应用严格的 GRADE 方法。它也有几个局限性。该主题的文献不断快速发展;我们的结果基于需要不断重新评估的发现。它仅关注微创手术技术,不能考虑更广泛的问题(例如,诊断、手术指征、术前康复)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f98/10359438/7fc558646426/13304_2023_1534_Fig1_HTML.jpg

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