Italian guidelines for the surgical management of enteral stomas in adults

Ferrara, Francesco; Parini, Dario; Bondurri, A.; Veltri, Marco; Barbierato, Maria; Pata, Francesco; Cattaneo, Francesca; Tafuri, Alessandro; Forni, Cristiana; Roveron, Gabriele; Rizzo, Gianluca

doi:10.1007/s10151-019-02099-3

Cited by 28 publications

(34 citation statements)

References 164 publications

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“…A meta-analysis that included four RCTs with 319 participants showed that the pursestring closure technique compared with the conventional primary closure group resulted in a significant decrease in surgical site infection (RD = − 0.25; P < 0.00001) [ 218 , 219 ].…”

Section: Resultsmentioning

confidence: 99%

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

et al. 2021

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Background and aims Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts’ consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods The discussion among the steering group of clinical experts and methodologists from the societies’ expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020–January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.

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Section: Resultsmentioning

confidence: 99%

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

et al. 2021

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“…Many studies proved the site of the stoma maturation has no impact on the development of para-stomal hernia. [13][14][15] This point i.e. the site of stoma exteriorization, is still a matter of debate.…”

Section: Discussionmentioning

confidence: 99%

Posterior Wall Colon Half Anastomosis for Fecal Diversion; a Pilot Prospective Study

Hamed¹,

Sabry²,

Afifi³

2020

Ain Shams Journal of Surgery

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Background: Colonic diversion is a common procedure in the practice of colo-rectal surgery; whether on emergent or elective basis. This "diversion", taking place after colon resection when primary anastomosis is "risky", takes one of two forms i.e divided or loop form. We introduced a modification for the double-barrel colostomy technique into a hand-sewn loop colostomy at the two divided ends achieving fecal diversion and at the same time assessing the healing power in the patient during the initial operation.Patients and method: Fifty patients, candidate for fecal diversion after right colonic resection, having different risk factors for anastomotic leakage, were recruited. A posterior wall half colonic anastomosis was done between both resection ends before exteriorization in those patients instead of performing an ileostomy and a mucus fistula. Patients, then, completed their treatment plan for the primary pathology and their stomas were closed lately as "a loop" ileocolostomy without the need for re-laparotomy.Results: All patients (with the except of one patient) had uneventful postoperative course following fecal diversion using the "hand-sewn loop" technique as regards bowl viability and fixation with all the patients being lately closed successfully without the need for re-laparotomy. Conclusion:Performing a posterior wall half-anastomosis at the initial operation of fecal diversion is a feasible option for patients undergoing fecal diversion after partial colonic resection, helping to avoid morbidities encountered during the operation of restoration of bowl continuity while, simultaneously, testing for hidden risks for anastomotic leakage.

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“…Several studies have demonstrated the effectiveness of information tools (such as brochures, also multimedia) in learning stoma care practices [25]. Therefore, the educational phase of stoma care should be implemented with multimedia and other types of information tools.…”

Section: Inpatient Managementmentioning

confidence: 99%

“…First, stoma siting, carried out by a specialist surgeon or a stoma nurse, represents a mandatory and essential procedure even in the COVID-19 era [25,36].…”

Section: Inpatient Managementmentioning

confidence: 99%