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Review
. 2023 Oct 10;18(1):48.
doi: 10.1186/s13017-023-00516-5.

Surgical management of ostomy complications: a MISSTO-WSES mapping review

Dario Parini  1 , Andrea Bondurri  2 , Francesco Ferrara  3 , Gianluca Rizzo  4 , Francesco Pata  5   6 , Marco Veltri  7 , Cristiana Forni  8 , Federico Coccolini  9 , Walt L Biffl  10 , Massimo Sartelli  11 , Yoram Kluger  12 , Luca Ansaloni  13 , Ernest Moore  14 , Fausto Catena  15 , Piergiorgio Danelli  16   17 ; Multidisciplinary Italian Study group for STOmas (MISSTO)
Affiliations
Review

Surgical management of ostomy complications: a MISSTO-WSES mapping review

Dario Parini et al. World J Emerg Surg. .

Abstract

Background: The creation of an ileostomy or colostomy is a common surgical event, both in elective and in emergency context. The main aim of stoma creation is to prevent postoperative complications, such as the anastomotic leak. However, stoma-related complications can also occur and their morbidity is not negligible, with a rate from 20 to 70%. Most stomal complications are managed conservatively, but, when this approach is not resolutive, surgical treatment becomes necessary. The aim of this mapping review is to get a comprehensive overview on the incidence, the risk factors, and the management of the main early and late ostomy complications: stoma necrosis, mucocutaneous separation, stoma retraction, stoma prolapse, parastomal hernia, stoma stenosis, and stoma bleeding.

Material and methods: A complete literature research in principal databases (PUBMED, EMBASE, SCOPUS and COCHRANE) was performed by Multidisciplinary Italian Study group for STOmas (MISSTO) for each topic, with no language restriction and limited to the years 2011-2021. An international expert panel, from MISSTO and World Society of Emergency Surgery (WSES), subsequently reviewed the different issues, endorsed the project, and approved the final manuscript.

Conclusion: Stoma-related complications are common and require a step-up management, from conservative stoma care to surgical stoma revision. A study of literature evidence in clinical practice for stoma creation and an improved management of stoma-related complications could significantly increase the quality of life of patients with ostomy. Solid evidence from the literature about the correct management is lacking, and an international consensus is needed to draw up new guidelines on this subject.

Keywords: Mucocutaneous separation; Parastomal hernia; Review; Stoma bleeding; Stoma complication; Stoma necrosis; Stoma prolapse; Stoma retraction; Stoma stenosis; Surgical management.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Stomal varices. Stomal varices classification revised from Saad’s article [91]. Type-a is non-occlusive and is pressure driven (oncotic), usually with some element of portosystemic collaterals (type-a2 and -a3) to decompress the higher portal pressure. A: parastomal varices. B: Afferent portal branch vein. C: Efferent systemic vein. PV portal vein. IFV ilio-femoral branch vein
See this image and copyright information in PMC

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