Crohn's Disease-Related Stoma Complications and Their Impact on Postsurgical Course.

INTRODUCTION: Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. The diversion through a colostomy or an ileostomy is sometimes required for disease control. In these patients, common stoma-related complications sum up with CD-related complications and often require revisional surgery. METHODS: The aim of the study was to assess stoma morbidity after surgery for CD and to identify the burden of CD-related or CD-associated complications. Thus, details of past medical history, surgery, and follow-up of 54 consecutive patients operated on for CD with any sort of stoma were retrieved from the stoma therapist prospectively maintained database. RESULTS: In our series, 23 patients had a colostomy, and 31 patients had an ileostomy. Complications occurred after stoma creation in 38 patients (70%) at a median of 1.3 months (interquartile range 0.6-7.2). CD-related complications arose in 8 patients (including pyoderma gangrenosum in 3 patients, peristomal fistulae in 2, granulomas in 2, and peristomal abscess in 1). Patients with CD-related complications tended to have a shorter disease duration (p = 0.07) and higher occurrence of CD-related complications was associated with end-stoma (p = 0.006). In this cohort, 11 cases had to be surgically treated for peristomal fistulae or abscess, parastomal hernia, prolapse, pyoderma gangrenosum, and recurrent CD. DISCUSSION/CONCLUSIONS: In patients with CD, stoma creation is burdened by a high rate of postoperative complication and a relevant rate is specifically related to CD. Often these patients are required to be reoperated on to redo the stoma. Moreover, end-stoma configuration and aggressive CD phenotype are associated to a higher rate of complications.

Surgical management of urinary diversion and stomas in adults: multidisciplinary Italian panel guidelines.

INTRODUCTION: Urinary stomas represent a worldwide medical and social problem. Data from literature about stoma management are extensive, but inhomogeneous. No guidelines exist about this topic. Therefore, clear, and comprehensive clinical guidelines based on evidence-based data and best practice are needed. The aim of this article was to elaborate guidelines for practice management of urinary stomas in adults. EVIDENCE ACQUISITION: Experts guided review of the literature was performed in PubMed, National Guideline Clearing-house and other databases (updated March 31, 2018). The research included guidelines, systematic reviews, meta-analysis, 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 level of scientific evidence statements a consensus conference composed by expert members of the major Italian scientific societies in the field of stoma management and care was performed. EVIDENCE SYNTHESIS: After discussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines with definitive recommendations was elaborated and prepared for publication. This manuscript is focused on statements about surgical management of urinary stomas. These guidelines include recommendations for adult patients only, articles published in English or Italian and with complete text available. CONCLUSIONS: These guidelines represent the first Italian guidelines about urinary stoma multidisciplinary management with the aim to assist urologists and stoma specialized nurses during the urinary stoma management and care.

The SYSTEMIC Project: A Pilot Study to Develop a Registry of Patients With an Ostomy for Predictive Modeling of Outcomes.

BACKGROUND: Stomal and peristomal skin complications represent a significant burden on the physical and psychological well-being of patients. PURPOSE: To develop a predictive tool for identifying the risk of complications in patients following ostomy surgery. METHODS: The oStomY regiSTry prEdictive ModelIng outCome (SYSTEMIC) project was developed to improve patient-oriented outcomes. Demographic, medical history, and stoma-related variables were obtained from patients at the wound ostomy clinic of the University Hospital of Padova, Italy. A follow-up assessment was completed 30 days after stoma surgery. Two (2) Bayesian machine learning approaches (naïve Bayes) were carried out to define an automatic peristomal complication predictive tool. A sensitivity analysis was performed to evaluate the possible effects of the prior choices on naïve Bayes performance. RESULTS: The algorithms were based on preliminary data from 52 patients (28 [53.3%] had a colostomy and 24 [46.7%] had an ileostomy). In terms of postoperative complications, no significant differences were observed between patients with different body mass indices (P = .16), those who underwent elective surgery compared with those who underwent emergency surgery (P = .66), and those who had or had not been preoperatively sited (P = .44). The algorithms showed an overall moderate ability to correctly classify patients according to the presence of peristomal complications (accuracy of nearly 70% in both models). In the the data-driven prior model, the probability of developing complications was greater for  participants with malignancies or other diseases (0.3314 for both levels) than for patients with diverticula and bowel perforation (0.1453) or inflammatory bowel disease (0.1918). CONCLUSION: The development of an easy-to-use algorithm may help nonspecialized nurses evaluate the likelihood of future peristomal complications in patients with an ostomy and implement preemptive measures.

Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults: An Executive Summary.

PURPOSE: This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults. METHODS: Scoping review and generation of evidence and consensus-based clinical guidelines. SEARCH STRATEGY: The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous 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" (for enteral stomas)." All the studies were evaluated according to the GRADE system and 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 discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication. FINDINGS/CONCLUSIONS: This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.

Peristomal allergic contact dermatitis caused by ostoma pastes and role of Gantrez ES-425.

BACKGROUND: Peristomal allergic contact dermatitis is an emerging problem and contact sensitization is probably more common than previously thought. Our objective was to identify sensitization to the most common topical equipment for ostomy in patients with history of peristomal dermatitis. METHODS: Twenty-six patients with suspected peristomal contact dermatitis were patch tested with our standard series and with products for stoma care (adhesive pastes, powders, adhesive skin barriers). Thirteen patients and 20 volunteers were also patch tested with Gantrez ES-425, which is a common component of adhesive pastes. RESULTS: Eighteen patients showed one or more positive reactions, 12 to one or more of the most commonly used adhesive pastes. Ten out of 13 patients tested to Gantrez ES-425 had a positive reaction. CONCLUSIONS: Allergic contact dermatitis of the peristomal area is probably more common than previously reported. Patch testing is the method of choice to determine sensitization to products for stoma care, and Gantrez ES-425 should be considered for patch testing.

Design and validation of a "Peristomal Lesion Scale" for peristomal skin assessment.

Many people in Italy undergo ostomy because of illness, and this can have negative psychological and physical effects. It is estimated that 15%-43% of ostomates suffer from skin complications in the peristomal area. During their life, many ostomates experience at least one peristomal lesion, and they turn to stomal therapy centres where trained nurses provide patient care and manage skin complications. To ensure a good quality of life for patients, and to take prompt action for the prevention and treatment of stomal lesions, it is essential to use appropriate assessment tools. The aim of this study was to develop a reliable peristomal skin assessment tool (Peristomal Lesion Scale [PLS]) for classifying lesions based on their severity; and to compare its validity with the most widely used peristomal tool in Italy, SACS. The new tool was designed by a team of experts, focusing on patients' demographics, clinical characteristics, and classification of the lesions by severity and topography. The results of this comparative validation study indicate that the PLS better discriminates lesions by their severity because of its level of detail, using a standardised terminology, and its completeness. The PLS is a valid tool for use in the daily work of stomal therapists.

Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy (PEG/PEJ) in Adult Patients: An Executive Summary.

Enteral nutrition (EN) is the introduction of nutrients into the gastrointestinal tract through a tube placed in a natural or artificial stoma. Tubes may be passed into the stomach (gastrostomy) or the jejunum (jejunostomy) in patients who cannot obtain adequate nourishing via oral feeding. Following placement, nurses are typically responsible for management of gastrostomy or other enteral tube devices in both the acute and home care settings. This article summarizes guidelines developed for nursing management of percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEJ) and gastrojejunostomy (PEGJ) tubes, developed by the Italian Association of Stoma care Nurses (AIOSS-Associazione Italiana Operatori Sanitari di Stomaterapia) in collaboration with the Italian Association of Endoscopic Operators (ANOTE-Associazione Nazionale Operatori Tecniche Endoscopiche) and the Italian Association of Gastroenterology Nurses and Associates (ANIGEA-Associazione Nazionale Infermieri di Gastroenterologia e Associati). The guidelines do not contain recommendations about EN through nasogastric tubes, indications for PEG/PEJ/PEGJ positioning, composition of EN, selection of patients, type of tube, modality of administration of the EN, and gastrointestinal complications.

Italian Society of Surgery and Association of Stoma Care Nurses Joint Position Statement on Preoperative Stoma Siting.

Drawing on the existing position statements approved by the Wound, Ostomy and Continence Nursing Society in collaboration with the American Society of Colon & Rectal Surgeons and the American Urological Association, the Italian Association of Stoma care Nurses and the Italian Society of Surgery jointly developed and approved this document on July 27, 2013. Its purpose was to provide a formal recommendation for preoperative stoma siting and associated counseling for all patients undergoing enterostomy or urostomy surgery, with the goals of preventing complications, enhancing health-related quality of life, improving care, achieving better health outcomes, and reducing health care costs.