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Italian guidelines for the surgical management of enteral stomas in adults

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

These guidelines are the first Italian guidelines on multidisciplinary management of enteral stomas with the aim of assisting surgeons during stoma management and care.

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Acknowledgements

Special thanks to AIOSS for the original contribution and support to the project, with great ability to aggregate different healthcare professionals and scientific societies.

Contributing Members of the MISSTO project: Maria Dolores D’Elia, Patrizio Capelli, Roberto Dino Villani, Adolfo Renzi, Salvatore Siracusano, Maria Russo, Concetta Balzotti, Stefano Mancini, Roberto Aloesio, Loriano Bagnoli, Antonio Ferrazzano, Antonio D’Elia and Maria De Pasquale, on behalf of: AIOSS (Italian Association of Stoma Care Operators), SIC (Italian Society of Surgery), ACOI (Italian Association of Hospital Surgeons), SICCR (Italian Society of ColoRectal Surgery), SICO (Italian Society of Surgical Oncology), SIUCP (Italian Unitary Society of ColoProctology), SIU (Italian Society of Urology), AIURO (Italian Association of Urologic Nurses), AMICI (Association of Inflammatory Bowel Diseases), FAIS (Federative Association of Incontinent and Stoma Patients), and AISTOM (Italian Association of Stoma Patients).

Funding

Travels and/or accommodations to meetings for the study group were supported by AIOSS (Associazione Italiana Operatori Sanitari Stomaterapia); travels to the first meeting for urologists were supported by SIU (Società Italiana di Urologia). These supports did not influence the content of the guidelines.

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Authors and Affiliations

  1. Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Via Pio II n.3, 20153, Milan, Italy

    F. Ferrara

  2. General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy

    D. Parini

  3. Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy

    A. Bondurri

  4. General Surgery Unit, San Jacopo Hospital, Pistoia, Italy

    M. Veltri

  5. Ostomy Centre, Azienda Ospedaliera di Padova, Padua, Italy

    M. Barbierato

  6. General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy

    F. Pata

  7. Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy

    F. Cattaneo

  8. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    A. Tafuri

  9. Nursing and Allied Profession Research Unit, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy

    C. Forni

  10. Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy

    G. Roveron

  11. Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

    G. Rizzo

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  1. F. Ferrara
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  2. D. Parini
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  8. A. Tafuri
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  9. C. Forni
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  11. G. Rizzo
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Consortia

Multidisciplinary Italian Study group for STOmas (MISSTO)

  • Maria Dolores D’Elia
  • , Patrizio Capelli
  • , Roberto Dino Villani
  • , Adolfo Renzi
  • , Salvatore Siracusano
  • , Maria Russo
  • , Concetta Balzotti
  • , Stefano Mancini
  • , Roberto Aloesio
  • , Loriano Bagnoli
  • , Antonio Ferrazzano
  • , Antonio D’Elia
  •  & Maria De Pasquale

Contributions

All authors contributed to the study conception, design, material preparation, data collection, and analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to F. Ferrara.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed consent

No need of informed consent since no human subject was included in the study.

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Multidisciplinary Italian Study group for STOmas (MISSTO) contributors are listed in the Acknowledgement section.

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Ferrara, F., Parini, D., Bondurri, A. et al. Italian guidelines for the surgical management of enteral stomas in adults. Tech Coloproctol 23, 1037–1056 (2019). https://doi.org/10.1007/s10151-019-02099-3

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