Italian guidelines for the surgical management of enteral stomas in adults

  • F. FerraraEmail author
  • D. Parini
  • A. Bondurri
  • M. Veltri
  • M. Barbierato
  • F. Pata
  • F. Cattaneo
  • A. Tafuri
  • C. Forni
  • G. Roveron
  • G. Rizzo
  • Multidisciplinary Italian Study group for STOmas (MISSTO)



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.


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.


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.


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


Stoma Ostomy Enterostomy Ileostomy Colostomy Surgery 



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).

Author contributions

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


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.

Compliance with ethical standard

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.


  1. 1.
    Goldberg M, Aukett LK, Carmel J et al (2010) Management of the patient with a fecal ostomy. J Wound Ostomy Cont Nurs 37:596–598. CrossRefGoogle Scholar
  2. 2.
    Italian Republic Senate (2015) Draft Law n. 2101.
  3. 3.
    De Salvo G (2005) Quanti siamo, sei anni dopo. Ritrovarci 2:15–16Google Scholar
  4. 4.
    Robertson I, Leung E, Hughes D et al (2005) Prospective analysis of stoma-related complications. Color Dis 7:279–285. CrossRefGoogle Scholar
  5. 5.
    Sheetz KH, Waits SA, Krell RW et al (2014) Complication rates of ostomy surgery are high and vary significantly between hospitals. Dis Colon Rectum 57:632–637. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rojanasarot S (2017) The impact of early involvement in a postdischarge support program for ostomy surgery patients on preventable healthcare utilization. J Wound Ostomy Cont Nurs. CrossRefGoogle Scholar
  7. 7.
    Ferrara F, Rizzo G, Bondurri A et al (2019) Italian guidelines for the management of enteral and urinary stomas. Dis Colon Rectum 62:3–4. CrossRefGoogle Scholar
  8. 8.
    Brouwers MC, Kho ME, Browman GP et al (2010) AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ 182:839–842. CrossRefGoogle Scholar
  9. 9.
    Guyatt G, Gutterman D, Baumann MH et al (2006) Grading strength of recommendations and quality of evidence in clinical guidelines. Chest 129:174–181. CrossRefPubMedGoogle Scholar
  10. 10.
    Forsmo HM, Pfeffer F, Rasdal A et al (2016) Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery. Int J Surg 36:121–126. CrossRefPubMedGoogle Scholar
  11. 11.
    Hendren S, Hammond K, Glasgow SC et al (2015) Clinical practice guidelines for ostomy surgery. Dis Colon Rectum 58:375–387. CrossRefPubMedGoogle Scholar
  12. 12.
    Scottish Intercollegiate Guidelines Network (SIGN). (2011) Diagnosis and management of colorectal cancerGoogle Scholar
  13. 13.
    Ronco M, Iona L, Fabbro C et al (2012) Patient education outcomes in surgery: a systematic review from 2004 to 2010. Int J Evid Based Healthc 10:309–323. CrossRefPubMedGoogle Scholar
  14. 14.
    Lo S-F, Wang Y-T, Wu L-Y et al (2009) A cost-effectiveness analysis of a multimedia learning education program for stoma patients. J Clin Nurs 19:1844–1854. CrossRefPubMedGoogle Scholar
  15. 15.
    Chaudhri S, Brown L, Hassan I, Horgan AF (2005) Preoperative intensive, community-based vs. traditional stoma education: a randomized controlled trial. Dis Colon Rectum 48:504–509. CrossRefPubMedGoogle Scholar
  16. 16.
    Zhang J, Wong FKY, You L et al (2013) Effects of enterostomal nurse telephone follow-up on postoperative adjustment of discharged colostomy patients. Cancer Nurs 36:419–428. CrossRefPubMedGoogle Scholar
  17. 17.
    Haugen V, Bliss DZ, Savik K (2006) Perioperative factors that affect long-term adjustment to an incontinent ostomy. J Wound Ostomy Cont Nurs 33:525–535CrossRefGoogle Scholar
  18. 18.
    Millan M, Tegido M, Biondo S, García-Granero E (2009) Preoperative stoma siting and education by stomatherapists in colorectal cancer patients: a descriptive study of 12 colorectal surgery units in spain. Color Dis. CrossRefGoogle Scholar
  19. 19.
    Altuntas YE, Kement M, Gezen C et al (2012) The role of group education on quality of life in patients with a stoma. Eur J Cancer Care (Engl) 21:776–781. CrossRefGoogle Scholar
  20. 20.
    Faury S, Koleck M, Foucaud J et al (2017) Patient education interventions for colorectal cancer patients with stoma: a systematic review. Patient Educ Couns 100:1807–1819. CrossRefPubMedGoogle Scholar
  21. 21.
    Bass EM, Del Pino A, Tan A et al (1997) Does preoperative stoma marking and education by the enterostomal therapist affect outcome? Dis Colon Rectum 40:440–442CrossRefGoogle Scholar
  22. 22.
    Mahjoubi B, Kiani Goodarzi K, Mohammad-Sadeghi H (2010) Quality of life in stoma patients: appropriate and inappropriate stoma sites. World J Surg 34:147–152. CrossRefPubMedGoogle Scholar
  23. 23.
    Nastro P, Knowles CH, McGrath A et al (2010) Complications of intestinal stomas. Br J Surg 97:1885–1889. CrossRefPubMedGoogle Scholar
  24. 24.
    Person B, Ifargan R, Lachter J et al (2012) The impact of preoperative stoma site marking on the incidence of complications, quality of life, and patient’s independence. Dis Colon Rectum 55:783–787. CrossRefPubMedGoogle Scholar
  25. 25.
    Baykara ZG, Demir SG, Karadag A et al (2014) A multicenter, retrospective study to evaluate the effect of preoperative stoma site marking on stomal and peristomal complications. Ostomy Wound Manage 60:16–26PubMedGoogle Scholar
  26. 26.
    Jayarajah U, Samarasekara AMP, Samarasekera DN (2016) A study of long-term complications associated with enteral ostomy and their contributory factors. BMC Res Notes 9:500. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    McKenna LS, Taggart E, Stoelting J et al (2016) The impact of preoperative stoma marking on health-related quality of life. J Wound Ostomy Cont Nurs 43:57–61. CrossRefGoogle Scholar
  28. 28.
    Carlsson E, Fingren J, Hallén A-M et al (2016) The prevalence of ostomy-related complications 1 year after ostomy surgery: a prospective, descriptive, clinical study. Ostomy Wound Manage 62:34–48PubMedGoogle Scholar
  29. 29.
    Colwell JC, Gray M (2007) Does preoperative teaching and stoma site marking affect surgical outcomes in patients undergoing ostomy surgery? J Wound Ostomy Cont Nurs 34:492–496. CrossRefGoogle Scholar
  30. 30.
    Arumugam PJ, Bevan L, Macdonald L et al (2003) A prospective audit of stomas–analysis of risk factors and complications and their management. Colorectal Dis 5:49–52CrossRefGoogle Scholar
  31. 31.
    Pittman J, Rawl SM, Schmidt CM et al (2008) Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. J Wound Ostomy Cont Nurs 35:493–503. CrossRefGoogle Scholar
  32. 32.
    Koc U, Karaman K, Gomceli I et al (2017) A retrospective analysis of factors affecting early stoma complications. Ostomy Wound Manage 63:28–32PubMedGoogle Scholar
  33. 33.
    Arolfo S, Borgiotto C, Bosio G, Mistrangelo M, Allaix ME, Morino M (2018) Preoperative stoma site marking: a simple practice to reduce stoma-related complications. Tech Coloproctol 22:683–687. CrossRefPubMedGoogle Scholar
  34. 34.
    Salvadalena G, Hendren S, McKenna L et al (2015) WOCN society and aua position statement on preoperative stoma site marking for patients undergoing urostomy surgery. J Wound Ostomy Cont Nurs 42:249–252. CrossRefGoogle Scholar
  35. 35.
    Roveron G, De Toma G, Barbierato M (2016) Italian society of surgery and association of stoma care nurses joint position statement on preoperative stoma siting. J Wound Ostomy Cont Nurs 43:165–169. CrossRefGoogle Scholar
  36. 36.
    Ludwig KA, Milsom JW, Garcia-Ruiz A, Fazio VW (1996) Laparoscopic techniques for fecal diversion. Dis Colon Rectum 39:285–288CrossRefGoogle Scholar
  37. 37.
    Oliveira L, Reissman P, Nogueras J, Wexner SD (1997) Laparoscopic creation of stomas. Surg Endosc 11:19–23CrossRefGoogle Scholar
  38. 38.
    Hollyoak MA, Lumley J, Stitz RW (1998) Laparoscopic stoma formation for faecal diversion. Br J Surg 85:226–228. CrossRefPubMedGoogle Scholar
  39. 39.
    Schwandner O, Schiedeck TH, Bruch HP (1998) Stoma creation for fecal diversion: is the laparoscopic technique appropriate? Int J Colorectal Dis 13:251–255CrossRefGoogle Scholar
  40. 40.
    Young CJ, Eyers AA, Solomon MJ (1998) Defunctioning of the anorectum: historical controlled study of laparoscopic vs. open procedures. Dis Colon Rectum 41:190–194CrossRefGoogle Scholar
  41. 41.
    Liu J, Bruch HP, Farke S et al (2005) Stoma formation for fecal diversion: a plea for the laparoscopic approach. Tech Coloproctol 9:9–14. CrossRefPubMedGoogle Scholar
  42. 42.
    Scheidbach H, Ptok H, Schubert D et al (2009) Palliative stoma creation: comparison of laparoscopic vs conventional procedures. Langenbeck’s Arch Surg 394:371–374. CrossRefGoogle Scholar
  43. 43.
    Gorgun E, Gezen FC, Aytac E et al (2015) Laparoscopic versus open fecal diversion: does laparoscopy offer better outcomes in short term? Tech Coloproctol 19:293–300. CrossRefPubMedGoogle Scholar
  44. 44.
    Ivatury SJ, Bostock Rosenzweig IC, Holubar SD (2016) Short-term outcomes after open and laparoscopic colostomy creation. Dis Colon Rectum 59:543–550. CrossRefPubMedGoogle Scholar
  45. 45.
    Ng KH, Ng DCK, Cheung HYS et al (2008) Obstructive complications of laparoscopically created defunctioning ileostomy. Dis Colon Rectum 51:1664–1668. CrossRefPubMedGoogle Scholar
  46. 46.
    Hiranyakas A, Rather A, da Silva G et al (2013) Loop ileostomy closure after laparoscopic versus open surgery: is there a difference? Surg Endosc 27:90–94. CrossRefPubMedGoogle Scholar
  47. 47.
    Williams NS, Nasmyth DG, Jones D, Smith AH (1986) De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg 73:566–570CrossRefGoogle Scholar
  48. 48.
    Khoury GA, Lewis MC, Meleagros L, Lewis AA (1987) Colostomy or ileostomy after colorectal anastomosis?: a randomised trial. Ann R Coll Surg Engl 69:5–7PubMedPubMedCentralGoogle Scholar
  49. 49.
    Gooszen AW, Geelkerken RH, Hermans J et al (1998) Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 85:76–79. CrossRefPubMedGoogle Scholar
  50. 50.
    Edwards DP, Leppington-Clarke A, Sexton R et al (2001) Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg 88:360–363. CrossRefPubMedGoogle Scholar
  51. 51.
    Law WL, Chu KW, Choi HK (2002) Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision. Br J Surg 89:704–708. CrossRefPubMedGoogle Scholar
  52. 52.
    Lertsithichai P, Rattanapichart P (2004) Temporary ileostomy versus temporary colostomy: a meta-analysis of complications. Asian J Surg 27:202–210. CrossRefPubMedGoogle Scholar
  53. 53.
    Güenaga KF, Lustosa SAS, Saad SS et al (2007) Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  54. 54.
    Rondelli F, Reboldi P, Rulli A et al (2009) Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 24:479–488. CrossRefPubMedGoogle Scholar
  55. 55.
    Chen J, Wang DR, Zhang JR et al (2013) Meta-analysis of temporary ileostomy versus colostomy for colorectal anastomoses. Acta Chir Belg 113:330–339CrossRefGoogle Scholar
  56. 56.
    Geng HZ, Nasier D, Liu B et al (2015) Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma. Ann R Coll Surg Engl 97:494–501. CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Li W, Stocchi L, Cherla D et al (2017) Factors associated with hospital readmission following diverting ileostomy creation. Tech Coloproctol 21:641–648. CrossRefPubMedGoogle Scholar
  58. 58.
    Shaffer VO, Owi T, Kumarusamy MA et al (2017) Decreasing hospital readmission in ileostomy patients: results of novel pilot program. J Am Coll Surg 224:425–430. CrossRefPubMedGoogle Scholar
  59. 59.
    Iqbal A, Raza A, Huang E et al (2017) Cost effectiveness of a novel attempt to reduce readmission after ileostomy creation. JSLS J Soc Laparoendosc Surg 21(e2016):00082. CrossRefGoogle Scholar
  60. 60.
    Fish DR, Mancuso CA, Garcia-Aguilar JE et al (2017) Readmission after ileostomy creation. Ann Surg 265:379–387. CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Paquette IM, Solan P, Rafferty JF et al (2013) Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum 56:974–979. CrossRefPubMedGoogle Scholar
  62. 62.
    Messaris E, Sehgal R, Deiling S et al (2012) Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum 55:175–180. CrossRefPubMedGoogle Scholar
  63. 63.
    Baker ML, Williams RN, Nightingale JMD (2011) Causes and management of a high-output stoma. Color Dis 13:191–197. CrossRefGoogle Scholar
  64. 64.
    Gooszen AW, Geelkerken RH, Hermans J et al (2000) Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 43:650–655CrossRefGoogle Scholar
  65. 65.
    Silva MA, Ratnayake G, Deen KI (2003) Quality of life of stoma patients: temporary ileostomy versus colostomy. World J Surg 27:421–424. CrossRefPubMedGoogle Scholar
  66. 66.
    Bruns BR, DuBose J, Pasley J et al (2015) Loop versus end colostomy reversal: has anything changed? Eur J Trauma Emerg Surg 41:539–543. CrossRefPubMedGoogle Scholar
  67. 67.
    Mak GZ, Harberg FJ, Hiatt P et al (2000) T-tube ileostomy for meconium ileus: four decades of experience. J Pediatr Surg 35:349–352CrossRefGoogle Scholar
  68. 68.
    Lizarralde E (1981) Typhoid perforation of the ileum in children. J Pediatr Surg 16:1012–1016CrossRefGoogle Scholar
  69. 69.
    Hojo K (1985) Total colectomy, rectal mucosectomy and ileoanal anastomosis for familial polyposis coli–use of tube ileostomy. Jpn J Clin Oncol 15:661–669PubMedGoogle Scholar
  70. 70.
    Zong Z, Zhou T, Jiang Z et al (2016) Temporary tube stoma versus conventional loop stoma for the protection of a low anastomosis in colorectal surgery: a systematic review and meta-analysis. Am Surg 82:251–258PubMedGoogle Scholar
  71. 71.
    Senapati A, Phillips RK (1991) The trephine colostomy: a permanent left iliac fossa end colostomy without recourse to laparotomy. Ann R Coll Surg Engl 73:305–306PubMedPubMedCentralGoogle Scholar
  72. 72.
    Parithivel VS, Schein M, Gerst PH (2003) Colonoscopy-assisted “trephine” sigmoid colostomy. Dig Surg 20:103–106. CrossRefPubMedGoogle Scholar
  73. 73.
    Brand M, Dujovny N (2008) Preoperative considerations and creation of normal ostomies. Clin Colon Rectal Surg 21:005–016. CrossRefGoogle Scholar
  74. 74.
    Speirs M, Leung E, Hughes D et al (2006) Ileostomy rod–Is it bridge too far? Color Dis 8:484–487. CrossRefGoogle Scholar
  75. 75.
    Zindel J, Gygax C, Studer P et al (2017) A sustaining rod increases necrosis of loop ileostomies: a randomized controlled trial. Int J Colorectal Dis 32:875–881. CrossRefPubMedGoogle Scholar
  76. 76.
    Uchino M, Ikeuchi H, Bando T et al (2017) Is an ostomy rod useful for bridging the retraction during the creation of a loop ileostomy? a randomized control trial. World J Surg 41:2128–2135. CrossRefPubMedGoogle Scholar
  77. 77.
    Franklyn J, Varghese G, Mittal R et al (2017) A prospective randomized controlled trial comparing early postoperative complications in patients undergoing loop colostomy with and without a stoma rod. Color Dis 19:675–680. CrossRefGoogle Scholar
  78. 78.
    Whiteley I, Russell M, Nassar N, Gladman MA (2016) Outcomes of support rod usage in loop stoma formation. Int J Colorectal Dis 31:1189–1195. CrossRefPubMedGoogle Scholar
  79. 79.
    Dziki Ł, Mik M, Trzciński R et al (2015) Evaluation of the early results of a loop stoma with a plastic rod in comparison to a loop stoma made with a skin bridge. Pol Prz Chir Polish J Surg 87:31–34. CrossRefGoogle Scholar
  80. 80.
    Harish K (2008) The loop stoma bridge-A new technique. J Gastrointest Surg 12:958–961. CrossRefPubMedGoogle Scholar
  81. 81.
    Lafreniere R, Ketcham AS (1985) The Penrose drain: a safe, atraumatic colostomy bridge. Am J Surg 149:288–291CrossRefGoogle Scholar
  82. 82.
    Scarpa M, Sadocchi L, Ruffolo C et al (2007) Rod in loop ileostomy: just an insignificant detail for ileostomy-related complications? Langenbeck’s Arch Surg 392:149–154. CrossRefGoogle Scholar
  83. 83.
    Parmar KL, Zammit M, Smith A et al (2011) A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. Color Dis 13:935–938. CrossRefGoogle Scholar
  84. 84.
    Cottam J, Richards K, Hasted A, Blackman A (2007) Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Color Dis 9:834–838. CrossRefGoogle Scholar
  85. 85.
    Lin AY (2013) End ileostomy and loop ileostomy. In: Fleshman J (ed) Atlas of surgical techniques for colon, rectum and anus. Saunders, Philadelphia, pp 354–362Google Scholar
  86. 86.
    Lin AY, Birnbaum EH (2013) Colostomy: end and divided loop. In: Fleshman J (ed) Atlas of surgical techniques for colon, rectum and anus. Saunders, Philadelphia, pp 363–370Google Scholar
  87. 87.
    Gore DC (2010) Brooke ileostomy. In: Townsend C, Evers B (eds) Atlas of general surgical techniques. Saunders, Philadelphia, pp 627–634CrossRefGoogle Scholar
  88. 88.
    Gore DC (2010) Loop colostomy. In: Townsend C, Evers B (eds) Atlas of general surgical techniques. Saunders, Philadelphia, pp 635–640CrossRefGoogle Scholar
  89. 89.
    Gore DC (2010) Diverting end colostomy with mucous fistula or hartmann’s pouch. In: Townsend C, Evers B (eds) Atlas of general surgical techniques. Saunders, Philadelphia, pp 617–626CrossRefGoogle Scholar
  90. 90.
    Couëtte C, Dumont F, Thibaudeau E (2018) Techniques des colostomies et traitement de leurs complications. EMC Techniques chirurgicales. Elsevier Masson, Paris, pp 1–25Google Scholar
  91. 91.
    Godiris-Petit G, Leyre P, Trésallet C, Ménégaux F (2010) Entérostomies chirurgicales. EMC Techniques chirurgicales. Elsevier Masson, Paris, pp 1–13Google Scholar
  92. 92.
    Hardt J, Seyfried S, Weiß C et al (2016) A pilot single-centre randomized trial assessing the safety and efficacy of lateral pararectus abdominis compared with transrectus abdominis muscle stoma placement in patients with temporary loop ileostomies: the PATRASTOM trial. Color Dis 18:O81–O90. CrossRefGoogle Scholar
  93. 93.
    Antoniou SA, Agresta F, Garcia Alamino JM et al (2018) European hernia society guidelines on prevention and treatment of parastomal hernias. Hernia 22:183–198. CrossRefPubMedGoogle Scholar
  94. 94.
    Li W, Benlice C, Stocchi L et al (2017) Does stoma site specimen extraction increase postoperative ileostomy complication rates? Surg Endosc 31:3552–3558. CrossRefPubMedGoogle Scholar
  95. 95.
    Hardt J, Meerpohl JJ, Metzendorf MI et al (2013) Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  96. 96.
    Chapman SJ, Wood B, Drake TM et al (2017) Systematic review and meta-analysis of prophylactic mesh during primary stoma formation to prevent parastomal hernia. Dis Colon Rectum 60:107–115. CrossRefPubMedGoogle Scholar
  97. 97.
    Cornille JB, Pathak S, Daniels IR, Smart NJ (2017) Prophylactic mesh use during primary stoma formation to prevent parastomal hernia. Ann R Coll Surg Engl 99:2–11. CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Cross AJ, Buchwald PL, Frizelle FA, Eglinton TW (2017) Meta-analysis of prophylactic mesh to prevent parastomal hernia. Br J Surg 104:179–186. CrossRefPubMedGoogle Scholar
  99. 99.
    Hauters P, Cardin JL, Lepere M et al (2016) Long-term assessment of parastomal hernia prevention by intra-peritoneal mesh reinforcement according to the modified Sugarbaker technique. Surg Endosc 30:5372–5379. CrossRefPubMedGoogle Scholar
  100. 100.
    López-Cano M, Brandsma HT, Bury K et al (2017) Prophylactic mesh to prevent parastomal hernia after end colostomy: a meta-analysis and trial sequential analysis. Hernia 21:177–189. CrossRefPubMedGoogle Scholar
  101. 101.
    Patel SV, Zhang L, Chadi SA, Wexner SD (2017) Prophylactic mesh to prevent parastomal hernia: a meta-analysis of randomized controlled studies. Tech Coloproctol 21:5–13. CrossRefPubMedGoogle Scholar
  102. 102.
    Pianka F, Probst P, Keller AV et al (2017) Prophylactic mesh placement for the PREvention of paraSTOmal hernias: the PRESTO systematic review and meta-analysis. PLoS One 12:1–15. CrossRefGoogle Scholar
  103. 103.
    Wang S, Wang W, Zhu B et al (2016) Efficacy of prophylactic mesh in end-colostomy construction: a systematic review and meta-analysis of randomized controlled trials. World J Surg 40:2528–2536. CrossRefPubMedPubMedCentralGoogle Scholar
  104. 104.
    Zhu J, Pu Y, Yang X et al (2016) Prophylactic mesh application during colostomy to prevent parastomal hernia: a meta-analysis. Gastroenterol Res Pract 2016:1–10. CrossRefGoogle Scholar
  105. 105.
    Odensten C, Strigård K, Rutegård J et al (2019) Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial-stomamesh. Ann Surg 269:427–431. CrossRefPubMedGoogle Scholar
  106. 106.
    Findlay JM, Wood CPJ, Cunningham C (2018) Prophylactic mesh reinforcement of stomas: a cost-effectiveness meta-analysis of randomised controlled trials. Tech Coloproctol 22:265–270. CrossRefPubMedPubMedCentralGoogle Scholar
  107. 107.
    Berger D (2008) Prevention of parastomal hernias by prophylactic use of a specially designed intraperitoneal onlay mesh (Dynamesh IPST). Hernia 12:243–246. CrossRefPubMedGoogle Scholar
  108. 108.
    Köhler G, Hofmann A, Lechner M et al (2016) Prevention of parastomal hernias with 3D funnel meshes in intraperitoneal onlay position by placement during initial stoma formation. Hernia 20:151–159. CrossRefPubMedGoogle Scholar
  109. 109.
    Conde-Muíño R, Díez J-L, Martínez A et al (2017) Preventing parastomal hernias with systematic intraperitoneal specifically designed mesh. BMC Surg 17:41. CrossRefPubMedPubMedCentralGoogle Scholar
  110. 110.
    Ng ZQ, Tan P, Theophilus M (2017) Stapled mesh stoma reinforcement technique (smart) in the prevention of parastomal hernia: a single-centre experience. Hernia 21:469–475. CrossRefPubMedGoogle Scholar
  111. 111.
    Canda AE, Terzi C, Agalar C et al (2018) Preventing parastomal hernia with modified stapled mesh stoma reinforcement technique (SMART) in patients who underwent surgery for rectal cancer: a case–control study. Hernia 22:379–384. CrossRefPubMedGoogle Scholar
  112. 112.
    Guarnero V, Hoffmann H, Hetzer F et al (2016) A new stomaplasty ring (Koring™) to prevent parastomal hernia: an observational multicenter Swiss study. Tech Coloproctol 20:293–297. CrossRefPubMedGoogle Scholar
  113. 113.
    Lykke A, Andersen JFB, Jorgensen LN, Mynster T (2017) Prevention of parastomal hernia in the emergency setting. Langenbeck’s Arch Surg. CrossRefGoogle Scholar
  114. 114.
    Shabbir J, Chaudhary BN, Dawson R (2012) A systematic review on the use of prophylactic mesh during primary stoma formation to prevent parastomal hernia formation. Color Dis 14:931–936. CrossRefGoogle Scholar
  115. 115.
    Hammond TM, Huang A, Prosser K et al (2008) Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 12:475–481. CrossRefPubMedGoogle Scholar
  116. 116.
    Jänes A, Cengiz Y, Israelsson LA (2010) Experiences with a prophylactic mesh in 93 consecutive ostomies. World J Surg 34:1637–1640. CrossRefPubMedGoogle Scholar
  117. 117.
    Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J et al (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249:583–587. CrossRefPubMedGoogle Scholar
  118. 118.
    Fortelny RH, Hofmann A, May C et al (2015) Prevention of a parastomal hernia by biological mesh reinforcement. Front Surg 2:53. CrossRefPubMedPubMedCentralGoogle Scholar
  119. 119.
    Köckerling F, Alam NN, Antoniou SA et al (2018) What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia 22:249–269. CrossRefPubMedPubMedCentralGoogle Scholar
  120. 120.
    Kroese LF, De Smet GHJ, Jeekel J et al (2016) Systematic review and meta-analysis of extraperitoneal versus transperitoneal colostomy for preventing parastomal hernia. Dis Colon Rectum 59:688–695. CrossRefPubMedGoogle Scholar
  121. 121.
    Lian L, Wu XR, He XS et al (2012) Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients. Int J Colorectal Dis 27:59–64. CrossRefPubMedGoogle Scholar
  122. 122.
    Mari FS, Di Cesare T, Novi L et al (2015) Does ghost ileostomy have a role in the laparoscopic rectal surgery era? A randomized controlled trial. Surg Endosc 29:2590–2597. CrossRefPubMedGoogle Scholar
  123. 123.
    Miccini M, Bonapasta SA, Gregori M et al (2010) Ghost ileostomy: real and potential advantages. Am J Surg 200:e55–e57. CrossRefPubMedGoogle Scholar
  124. 124.
    Gullà N, Trastulli S, Boselli C et al (2011) Ghost ileostomy after anterior resection for rectal cancer: a preliminary experience. Langenbeck’s Arch Surg 396:997–1007. CrossRefGoogle Scholar
  125. 125.
    Cerroni M, Cirocchi R, Morelli U et al (2011) Ghost Ileostomy with or without abdominal parietal split. World J Surg Oncol 9:92. CrossRefPubMedPubMedCentralGoogle Scholar
  126. 126.
    Mori L, Vita M, Razzetta F et al (2013) Ghost ileostomy in anterior resection for rectal carcinoma: is it worthwhile? Dis Colon Rectum 56:29–34. CrossRefPubMedGoogle Scholar
  127. 127.
    Lago V, Domingo S, Matute L et al (2017) Ghost ileostomy in advanced ovarian cancer. Gynecol Oncol 147:488. CrossRefPubMedGoogle Scholar
  128. 128.
    Donahue TF, Bochner BH, Sfakianos JP et al (2014) Risk factors for the development of parastomal hernia after radical cystectomy. J Urol 191:1708–1713. CrossRefPubMedGoogle Scholar
  129. 129.
    Liu NW, Hackney JT, Gellhaus PT et al (2014) Incidence and risk factors of parastomal hernia in patients undergoing radical cystectomy and ileal conduit diversion. J Urol 191:1313–1318. CrossRefPubMedGoogle Scholar
  130. 130.
    Narang SK, Alam NN, Campain NJ et al (2017) Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review. Hernia 21:163–175. CrossRefPubMedGoogle Scholar
  131. 131.
    Funahashi K, Suzuki T, Nagashima Y et al (2014) Risk factors for parastomal hernia in Japanese patients with permanent colostomy. Surg Today 44:1465–1469. CrossRefPubMedGoogle Scholar
  132. 132.
    De Raet J, Delvaux G, Haentjens P, Van Nieuwenhove Y (2008) Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum 51:1806–1809. CrossRefPubMedGoogle Scholar
  133. 133.
    Harilingam M, Sebastian J, Twum-Barima C et al (2017) Patient-related factors influence the risk of developing intestinal stoma complications in early post-operative period. ANZ J Surg 87:E116–E120. CrossRefPubMedGoogle Scholar
  134. 134.
    Nybæk H, Knudsen DB, Laursen TN et al (2009) Skin problems in ostomy patients: a case-control study of risk factors. Acta Derm Venereol 89:64–67. CrossRefPubMedGoogle Scholar
  135. 135.
    Sung YH, Kwon I, Jo S, Park S (2010) Factors affecting ostomy-related complications in Korea. J Wound Ostomy Cont Nurs 37:166–172. CrossRefGoogle Scholar
  136. 136.
    Caricato M, Ausania F, Ripetti V et al (2007) Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Color Dis 9:559–561. CrossRefGoogle Scholar
  137. 137.
    Persson E, Berndtsson I, Carlsson E et al (2010) Stoma-related complications and stoma size - a 2-year follow up. Color Dis 12:971–976. CrossRefGoogle Scholar
  138. 138.
    Wu XR, Mukewar S, Kiran RP et al (2013) Risk factors for peristomal pyoderma gangrenosum complicating inflammatory bowel disease. J Crohn’s Colitis 7:e171–e177. CrossRefGoogle Scholar
  139. 139.
    Alves A, Panis Y, Lelong B et al (2008) Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg 95:693–698. CrossRefPubMedGoogle Scholar
  140. 140.
    Park J, Danielsen AK, Angenete E et al (2018) Quality of life in a randomized trial of early closure of temporary ileostomy after rectal resection for cancer (EASY trial). Br J Surg 105:244–251. CrossRefPubMedGoogle Scholar
  141. 141.
    Lasithiotakis K, Aghahoseini A, Alexander D (2016) Is early reversal of defunctioning ileostomy a shorter, easier and less expensive operation? World J Surg 40:1737–1740. CrossRefPubMedGoogle Scholar
  142. 142.
    Nelson T, Pranavi A, Sureshkumar S et al (2018) Early versus conventional stoma closure following bowel surgery: a randomized controlled trial. Saudi J Gastroenterol 24:52. CrossRefPubMedPubMedCentralGoogle Scholar
  143. 143.
    Farag S, Rehman S, Sains P et al (2017) Early vs delayed closure of loop defunctioning ileostomy in patients undergoing distal colorectal resections: an integrated systematic review and meta-analysis of published randomized controlled trials. Color Dis 19:1050–1057. CrossRefGoogle Scholar
  144. 144.
    Menahem B, Lubrano J, Vallois A, Alves A (2018) Early closure of defunctioning loop ileostomy: is it beneficial for the patient? a meta-analysis. World J Surg 42:3171–3178. CrossRefPubMedGoogle Scholar
  145. 145.
    Di Carlo I, Toro A, Pannofino O et al (2010) Laparoscopic versus open restoration of intestinal continuity after Hartmann procedure. Hepatogastroenterology 57:232–235PubMedGoogle Scholar
  146. 146.
    Keck JO, Collopy BT, Ryan PJ et al (1994) Reversal of hartmann’s procedure: effect of timing and technique on ease and safety. Dis Colon Rectum 37:243–248CrossRefGoogle Scholar
  147. 147.
    Slawik S, Dixon AR (2008) Laparoscopic reversal of Hartmann’s rectosigmoidectomy. Colorectal Dis 10:81–83. CrossRefPubMedGoogle Scholar
  148. 148.
    Fleming FJ, Gillen P (2009) Reversal of Hartmann’s procedure following acute diverticulitis: is timing everything? Int J Colorectal Dis 24:1219–1225. CrossRefPubMedGoogle Scholar
  149. 149.
    Löffler T, Rossion I, Bruckner T et al (2012) HAnd suture versus stapling for closure of loop ileostomy (HASTA trial). Ann Surg 256:828–836. CrossRefPubMedGoogle Scholar
  150. 150.
    Shelygin YA, Chernyshov SV, Rybakov EG (2010) Stapled ileostomy closure results in reduction of postoperative morbidity. Tech Coloproctol 14:19–23. CrossRefPubMedGoogle Scholar
  151. 151.
    Hull TL, Kobe I, Fazio VW (1996) Comparison of handsewn with stapled loop ileostomy closures. Dis Colon Rectum 39:1086–1089CrossRefGoogle Scholar
  152. 152.
    Hasegawa H, Radley S, Morton DG, Keighley MR (2000) Stapled versus sutured closure of loop ileostomy: a randomized controlled trial. Ann Surg 231:202–204CrossRefGoogle Scholar
  153. 153.
    Madani R, Day N, Kumar L et al (2018) Hand-Sewn versus stapled closure of loop ileostomy: a meta-analysis. Dig Surg. CrossRefPubMedGoogle Scholar
  154. 154.
    Löffler T, Rossion I, Gooßen K et al (2015) Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials. Langenbeck’s Arch Surg 400:193–205. CrossRefGoogle Scholar
  155. 155.
    Sajid MS, Craciunas L, Baig MK, Sains P (2013) Systematic review and meta-analysis of published, randomized, controlled trials comparing suture anastomosis to stapled anastomosis for ileostomy closure. Tech Coloproctol 17:631–639. CrossRefPubMedGoogle Scholar
  156. 156.
    Markides GA, Wijetunga IU, Brown SR, Anwar S (2015) Meta-analysis of handsewn versus stapled reversal of loop ileostomy. ANZ J Surg 85:217–224. CrossRefPubMedGoogle Scholar
  157. 157.
    Celentano V, Giglio MC, Bucci L (2015) Laparoscopic versus open Hartmann’s reversal: a systematic review and meta-analysis. Int J Colorectal Dis 30:1603–1615. CrossRefPubMedGoogle Scholar
  158. 158.
    Siddiqui MRS, Sajid MS, Baig MK (2010) Open vs laparoscopic approach for reversal of Hartmann’s procedure: a systematic review. Colorectal Dis 12:733–741. CrossRefPubMedGoogle Scholar
  159. 159.
    Sherman KL, Wexner SD (2017) Considerations in stoma reversal. Clin Colon Rectal Surg 30:172–177. CrossRefPubMedPubMedCentralGoogle Scholar
  160. 160.
    Banerjee A (1997) Pursestring skin closure after stoma reversal. Dis Colon Rectum 40:993–994CrossRefGoogle Scholar
  161. 161.
    Rondelli F, Franco L, Balzarotti Canger RC et al (2018) Purse-string closure versus conventional primary closure of wound following stoma reversal: meta-analysis of randomized controlled trials. Int J Surg 52:208–213. CrossRefPubMedGoogle Scholar
  162. 162.
    Sajid MS, Bhatti MI, Miles WFA (2015) Systematic review and meta-analysis of published randomized controlled trials comparing purse-string vs conventional linear closure of the wound following ileostomy (stoma) closure. Gastroenterol Rep 3:156–161. CrossRefGoogle Scholar
  163. 163.
    Hsieh M-C, Kuo L-T, Chi C-C et al (2015) Pursestring closure versus conventional primary closure following stoma reversal to reduce surgical site infection rate. Dis Colon Rectum 58:808–815. CrossRefPubMedGoogle Scholar
  164. 164.
    McCartan DP, Burke JP, Walsh SR, Coffey JC (2013) Purse-string approximation is superior to primary skin closure following stoma reversal: a systematic review and meta-analysis. Tech Coloproctol 17:345–351. CrossRefPubMedGoogle Scholar
  165. 165.
    Li LT, Hicks SC, Davila JA et al (2014) Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: a systematic review and multiple treatment meta-analysis. Colorectal Dis 16:406–416. CrossRefPubMedGoogle Scholar
  166. 166.
    Li LT, Brahmbhatt R, Hicks SC et al (2014) Prevalence of surgical site infection at the stoma site following four skin closure techniques: a retrospective cohort study. Dig Surg 31:73–78. CrossRefPubMedGoogle Scholar
  167. 167.
    Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N et al (2013) Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum 56:205–211. CrossRefPubMedGoogle Scholar
  168. 168.
    Alvandipour M, Gharedaghi B, Khodabakhsh H, Karami MY (2016) Purse-string versus linear conventional skin wound closure of an ileostomy: a randomized clinical trial. Ann Coloproctol 32:144. CrossRefPubMedPubMedCentralGoogle Scholar
  169. 169.
    O’Leary DP, Carter M, Wijewardene D et al (2017) The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the “STOMA” trial. Tech Coloproctol 21:863–868. CrossRefPubMedGoogle Scholar
  170. 170.
    Lee JT, Marquez TT, Clerc D et al (2014) Pursestring closure of the stoma site leads to fewer wound infections. Dis Colon Rectum 57:1282–1289. CrossRefPubMedGoogle Scholar
  171. 171.
    Juratli MA, Nour-Eldin N-EA, Ackermann H et al (2018) Purse-string closure technique reduces the incidence of incisional hernias following the reversal of temporary ileostomy. Int J Colorectal Dis 33:973–977. CrossRefPubMedGoogle Scholar
  172. 172.
    Livingston DH, Miller FB, Richardson JD (1989) Are the risks after colostomy closure exaggerated? Am J Surg 158:17–20CrossRefGoogle Scholar
  173. 173.
    Riesener KP, Lehnen W, Höfer M et al (1997) Morbidity of ileostomy and colostomy closure: impact of surgical technique and perioperative treatment. World J Surg 21:103–108CrossRefGoogle Scholar
  174. 174.
    Demetriades D, Pezikis A, Melissas J et al (1988) Factors influencing the morbidity of colostomy closure. Am J Surg 155:594–596CrossRefGoogle Scholar
  175. 175.
    Mirbagheri N, Dark J, Skinner S (2013) Factors predicting stomal wound closure infection rates. Tech Coloproctol 17:215–220. CrossRefPubMedGoogle Scholar
  176. 176.
    Haase O, Raue W, Böhm B et al (2005) Subcutaneous gentamycin implant to reduce wound infections after loop-ileostomy closure: a randomized, double-blind, placebo-controlled trial. Dis Colon Rectum 48:2025–2031. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • F. Ferrara
    • 1
    Email author
  • D. Parini
    • 2
  • A. Bondurri
    • 3
  • M. Veltri
    • 4
  • M. Barbierato
    • 5
  • F. Pata
    • 6
  • F. Cattaneo
    • 7
  • A. Tafuri
    • 8
  • C. Forni
    • 9
  • G. Roveron
    • 10
  • G. Rizzo
    • 11
  • Multidisciplinary Italian Study group for STOmas (MISSTO)
  1. 1.Department of SurgerySan Carlo Borromeo Hospital, ASST Santi Paolo e CarloMilanItaly
  2. 2.General Surgery UnitSanta Maria della Misericordia HospitalRovigoItaly
  3. 3.Department of General SurgeryLuigi Sacco University Hospital, ASST FBF-SaccoMilanItaly
  4. 4.General Surgery UnitSan Jacopo HospitalPistoiaItaly
  5. 5.Ostomy CentreAzienda Ospedaliera di PadovaPaduaItaly
  6. 6.General Surgery UnitNicola Giannettasio HospitalCorigliano-RossanoItaly
  7. 7.Department of Oncological and Surgical Sciences, Urology ClinicUniversity of PadovaPadovaItaly
  8. 8.Department of UrologyUniversity of Verona, Azienda Ospedaliera Universitaria Integrata VeronaVeronaItaly
  9. 9.Nursing and Allied Profession Research UnitIRCCS, Istituto Ortopedico RizzoliBolognaItaly
  10. 10.Ostomy and Pelvic Floor Rehabilitation CentreS. Maria Della Misericordia HospitalRovigoItaly
  11. 11.Department of SurgeryFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly

Personalised recommendations