F Ferrara1, D Parini2, A Bondurri3, M Veltri4, M Barbierato5, F Pata6, F Cattaneo7, A Tafuri8, C Forni9, G Roveron10, G Rizzo11. 1. Department of Surgery, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Via Pio II n.3, 20153, Milan, Italy. frr.fra@gmail.com. 2. General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy. 3. Department of General Surgery, Luigi Sacco University Hospital, ASST FBF-Sacco, Milan, Italy. 4. General Surgery Unit, San Jacopo Hospital, Pistoia, Italy. 5. Ostomy Centre, Azienda Ospedaliera di Padova, Padua, Italy. 6. General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy. 7. Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padova, Italy. 8. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy. 9. Nursing and Allied Profession Research Unit, IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy. 10. Ostomy and Pelvic Floor Rehabilitation Centre, S. Maria Della Misericordia Hospital, Rovigo, Italy. 11. Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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.
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.
Entities:
Keywords:
Colostomy; Enterostomy; Ileostomy; Ostomy; Stoma; Surgery
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