Vol. 2 No. 1 (2023): infermieristica journal: it's TIME to care
Articles

Stoma and peristomal complications: a rapid overview of the literature

PDF
  • Giorgia Chirco,
  • Mario Antonini
Giorgia Chirco
Fondazione Don Carlo Gnocchi, Firenze
Mario Antonini
Ostomy Rehabilitation Center (CE.RI.STOM) Azienda USL Toscana Centro, Empoli, Italy
Bio
DOI: https://doi.org/10.36253/if-2075

Published 2023-04-30

Keywords

  • Ostomy,
  • Stoma complications,
  • Peristomal complications,
  • Stoma edema,
  • Malpositioning,
  • Malpacking,
  • Lesions,
  • Proliferative Lesions,
  • Peristomal Skin Infection,
  • Stoma and Peristomal Atypia
    • ...More
    Less
Copyright Notice

Abstract

Complications of the stoma complex are estimated to occur in 20-70% of the ostomized population. These studies, however, appear to show contradictions in terms of definitions of the same complications, making the results of the analyses of incidence and prevalence of the phenomenon inconsistent with each other. The absence of clear and unambiguous definitions, does not allow clear evidence to be defined in science; moreover, this is reflected in the absence of a standardized clinical-care approach, which inevitably hinders the spread of an organizational and methodological culture aimed at the wellness and autonomy of the subject. In order to overcome this obstacle, different classifications of complications have been proposed throughout the years, differentiating these exclusively into macro categories, without delving into them in detail. In this regard, this review aims to clearly define, from the general to the particular, the individual complications of the stoma complex so as to provide nurses an instrument that can help them in the prevention and recognition of these.

PDF

References

  1. Krouse RS, Herrinton LJ, Grant M, Wendel CS, Green SB, Mohler MJ, Baldwin CM, McMullen CK, Rawl SM, Matayoshi E, Coons SJ, Hornbrook MC. Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol. 2009 Oct 1;27(28):4664-70. doi: 10.1200/JCO.2008.20.9502. Epub 2009 Aug 31. PMID: 19720920; PMCID: PMC2754912ù
  2. Jayarajah, U., Samarasekara, A.M.P. & Samarasekera, D.N. A study of long-term complications associated with enteral ostomy and their contributory factors. BMC. 2016; Res Notes 9, 500. https://doi.org/10.1186/s13104-016-2304-z
  3. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis. 2010 Oct;12(10):958-64. doi: 10.1111/j.1463-1318.2009.02006.x. PMID: 19604288.
  4. Wound, Ostomy and Continence Nurses Society (WOCN) (2005). Stoma complications: best practice for clinicians. Mount Laurel, NJ: Author. Retrieved from www.wocn.org; Wound, Ostomy and Continence Nurses Society (WOCN) (2007). Stoma complications: best practice for clinicians. Mount Laurel, NJ: Author. Retrieved from www.wocn.org,
  5. Steinhagen E, Colwell J, Cannon LM. Intestinal Stoma-Postoperative Stoma Care and Peristomal Skin Complications. Clin Colon Rectal Surg 2017; 30:184-192.
  6. Krishnamurty DM, Blatnik J, Mutch M. Stoma Complication. Clin Colon Rectal Surg 2017; 30:193-200.
  7. Dellafiore F., Caruso R., Villa G. et al. Quali sono i fattori di rischio e la prevalenza delle complicanze stomali? Risultati di una revisione sistematica della letteratura e meta-analisi in “Memorial Gian Carlo Canese”. Atti del 3° Congresso Nazionale AIOSS “Stomaterapia e dintorni professionali”, a cura di C. Saracco, AIOSS, Montesilvano: Ottobre 2021. 4-38. https://aioss.it/wp-content/uploads/2021/10/memorial-canese-1a-edizione.pdf
  8. Salvadalena GD. The incidence of stoma and peristomal complications during the first 3 months after ostomy creation. J Wound Ostomy Continence Nurs. 2013 Jul-Aug;40(4):400-6.
  9. Malik TAM, Lee MJ, Harikrishnam AB. The incidence of stoma related morbility – a systematic review of randomised controlled trials. Ann R Coll Surg Engl 2018; 100:501-508. doi: 10.1308/rcsann.2018.0126
  10. Ahmad Z, Sharma A, Saxena P, Choudhary A, Ahmed M. A clinical study of intestinal stomas: its indications and complications. Int J Res Med Sci. 2013 Nov;1(4):536-540 www.msjonline.org DOI: 10.5455/2320-6012.ijrms20131140
  11. Formijne Jonkers HA, Draaisma WA, Roskott AM, van Overbeeke AJ, Broeders IA, Consten EC. Early complications after stoma formation: a prospective cohort study in 100 patients with 1-year follow-up. Int J Colorectal Dis. 2012 Aug;27(8):1095-9. doi: 10.1007/s00384-012-1413-y. Epub 2012 Jan 31. PMID: 22302593.
  12. P Nastro, C H Knowles, A McGrath, B Heyman, T R C Porrett, P J Lunniss, Complications of intestinal stomas, British Journal of Surgery, Volume 97, Issue 12, December 2010, Pages 1885–1889, https://doi.org/10.1002/bjs.7259
  13. Bafford AC., Irani JL. Management and complications of stomas. Surg Clin North Am. 2013; 93(1):145-66.
  14. Parmar KL., Zammit M., Smith A., Kenyon D., Lees NP. Greater Manchester and Cheshire Colorectal Cancer Network. A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. Colorectal Dis. 2011; 13(8):935-38.
  15. Sung, Young Hee; Kwon, Ingak; Jo, Sungho; Park, Seungmi. Factors Affecting Ostomy-Related Complications in Korea. Journal of Wound, Ostomy and Continence Nursing 37(2):p 166-172, March 2010. | DOI: 10.1097/WON.0b013e3181cf7b76
  16. Harilingam M, Sebastian J, Twum-Barima C, Boshnaq M, Mangam S, Khushal A, Marzouk D, Tsavellas G. Patient-related factors influence the risk of developing intestinal stoma complications in early post-operative period. ANZ J Surg. 2017 Oct;87(10):E116-E120. doi: 10.1111/ans.13397. Epub 2015 Dec 3. PMID: 26631370.
  17. Koc U, Karaman K, Gomceli I, Dalgic T, Ozer I, Ulas M, Ercan M, Bostanci E, Akoglu M. A Retrospective Analysis of Factors Affecting Early Stoma Complications. Ostomy Wound Manage. 2017 Jan;63(1):28-32. PMID: 28112647.
  18. Miyo, M., Takemasa, I., Ikeda, M. et al. The influence of specific technical maneuvers utilized in the creation of diverting loop-ileostomies on stoma-related morbidity. Surg Today 47, 940–950 (2017). https://doi.org/10.1007/s00595-017-1481-2
  19. Szymanski KM, St-Cyr D, Alam T, Kassouf W. External stoma and peristomal complications following radical cystectomy and ileal conduit diversion: a systematic review. Ostomy Wound Manage. 2010 Jan 1;56(1):28-35. PMID: 20093715.
  20. Landmann RG, Cashman AL. Ileostomy or Colostomy care and complications. UpTODate: Nov 16, 2021. https://www.medilib.ir/uptodate/show/1384
  21. Murken DR, Bleier JIS. Ostomy-Related Complications. Clin Colon Rectal Surg. 2019 May;32(3):176-182. doi: 10.1055/s-0038-1676995. Epub 2019 Apr 2. PMID: 31061647; PMCID: PMC6494607.
  22. Aboulian A. Ostomy Complications in Crohn's Disease. Clin Colon Rectal Surg. 2019 Jul;32(4):314-322. doi: 10.1055/s-0039-1683924. Epub 2019 Jun 17. PMID: 31275079; PMCID: PMC6606323.
  23. Schiergens TS, Hoffmann V, Schobel TN, Englert GH, Kreis ME, Thasler WE, Werner J, Kasparek MS. Long-term Quality of Life of Patients With Permanent End Ileostomy: Results of a Nationwide Cross-Sectional Survey. Dis Colon Rectum. 2017 Jan;60(1):51-60. doi: 10.1097/DCR.0000000000000732. PMID: 27926557.
  24. Lindholm E, Persson E, Carlsson E, Hallén AM, Fingren J, Berndtsson I. Ostomy-related complications after emergent abdominal surgery: a 2-year follow-up study. J Wound Ostomy Continence Nurs. 2013 Nov-Dec;40(6):603-10. doi: 10.1097/WON.0b013e3182a9a7d9. PMID: 24108321.
  25. Antoniou SA, Agresta T, Garcia Alamino JM, et al. European Hernia Society giudelines on prevention and treatment of parastomal hernias. Hernia 2018; 22:183-98.
  26. Tsujinaka S, Tan KY, Miyakura Y, Fukano R, Oshima M, Konishi F, Rikiyama T. Current Management of Intestinal Stomas and Their Complications. J Anus Rectum Colon. 2020 Jan 30;4(1):25-33. doi: 10.23922/jarc.2019-032. PMID: 32002473; PMCID: PMC6989127.
  27. Park, Jemin M.D.; Rivard, Samantha J. M.D.; Maguire, Lillias M.D.; Varlamos, Christopher B.S.; Duby, Ashley M.S.; Hendren, Samantha M.D., M.P.H.. Parastomal Hernia Rates and Exercise Following Ostomy Surgery. Diseases of the Colon & Rectum ():, January 31, 2022. | DOI: 10.1097/DCR.0000000000002395
  28. Liu L, Zheng L, Zhang M, Hu J, Lu Y, Wang D. Incidence and risk factors for parastomal hernia with a permanent colostomy. J Surg Oncol. 2022 Sep;126(3):535-543. doi: 10.1002/jso.26919. Epub 2022 May 24. PMID: 35608292.
  29. Shiraishi T, Nishizawa Y, Ikeda K, Tsukada Y, Sasaki T, Ito M. Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery era. BMC Surg. 2020 Jun 22;20(1):141. doi: 10.1186/s12893-020-00802-y. PMID: 32571293; PMCID: PMC7310075.
  30. Pilgrim, Charles H. C. M.B.B.S. (Hons.), F.R.A.C.S.1,2; McIntyre, Richard M.B.B.S., F.R.A.C.S.2; Bailey, Michael Ph.D., M.Sc. (Statistics), B.Sc. (Hons.)1,3. Prospective Audit of Parastomal Hernia: Prevalence and Associated Comorbidities. Diseases of the Colon & Rectum 53(1):p 71-76, January 2010. | DOI: 10.1007/DCR.0b013e3181bdee8c
  31. Aquina CT, Iannuzzi JC, Probst CP, Kelly KN, Noyes K, Fleming FJ, Monson JR. Parastomal hernia: a growing problem with new solutions. Dig Surg. 2014;31(4-5):366-76. doi: 10.1159/000369279. Epub 2014 Dec 13. PMID: 25531238.
  32. Mehboob A, Perveen S, Iqbal M, Moula Bux K, Waheed A. Frequency and Complications of Ileostomy. Cureus. 2020 Oct 29;12(10):e11249. doi: 10.7759/cureus.11249. PMID: 33274131; PMCID: PMC7707129.
  33. Harraz AM, Elkarta A, Zahran MH, Elsawy AA, Elbaset MA, Elsorougy A, Osman Y, Mosbah A, Abol-Enein H, Shaaban AA. Parastomal hernia after ileal conduit urinary diversion: re-visiting the predictors radiologically and according to patient-reported outcome measures. Scand J Urol. 2020 Dec;54(6):501-507. doi: 10.1080/21681805.2020.1832144. Epub 2020 Oct 16. PMID: 33063578.
  34. Correa Marinez A, Bock D, Erestam S, Engström A, Kälebo P, Nielsen YW, Rosenberg J, Haglind E, Angenete E. Methods of Colostomy Construction: No Effect on Parastomal Hernia Rate: Results from Stoma-const-A Randomized Controlled Trial. Ann Surg. 2021 Apr 1;273(4):640-647. doi: 10.1097/SLA.0000000000003843. PMID: 32209907.
  35. Li Z, Zhang Z, Ma H, Yao K, Qin Z, Han H, Ye Y, Li Y, Dong P, Jiang L, Tian L, Liu Z, Zhou F. Extraperitonealization of ileal conduit reduces parastomal hernia after cystectomy and ileal conduit diversion. Urol Oncol. 2022 Apr;40(4):162.e17-162.e23. doi: 10.1016/j.urolonc.2021.11.022. Epub 2021 Dec 15. PMID: 34920945.
  36. Xie HF, Feng M, Cao SM, Jia YY, Gao P, Wang SH. Evidence summary for nonsurgical prevention and management of parastomal hernia in patients with enterostomy. Am J Transl Res. 2021 Nov 15;13(11):13173-13182. PMID: 34956538; PMCID: PMC8661159.
  37. Ambe PC, Kurz NR, Nitschke C, Odeh SF, Möslein G, Zirngibl H. Intestinal ostomy- classification, indications, ostomy care and complication management. Dtsch Arztebl Int. 2018; 115:182-7.
  38. Kalashnikova I., Achkasov S., Fadeeva S., Vorobiev G. The development and use of algorithms for diagnosing and choosing treatment of ostomy complications: results of a prospective evaluation. Ostomy Wound Management. 2011; 57(1):20-7.
  39. Antonini M, Barbierato M. Le complicanze del complesso stomale: valutazione e care infermieristico. In: A.I.O.S.S. Arte e scienza dell’assistenza infermieristica in stomaterapia: curare, prendersi cura, educare, a cura di Carla Saracco. Castellato (TE): Editpress S.r.l.; luglio 2021; 492-540
  40. Herlufsen P, Olsen AG, Carlsen B, et al. Study of peristomal skin disorders in patient with permanent stoma. Br J Nurs. 2006; 15:854-62.
  41. Anselmi L, Antonini M, Bosio G, Fonti A, Gasperini S, Mastonicola G, Militello G, Morandell C, Pisani F, Scrocca A. A proposal for classifying peristomal skin disorder: results of a multicenter observational study. Ostomy Wound Management 2007; 53(9): 38-43
  42. Antonini M, Bonaventura R, Militello G. Studio pilota sull’incidenza delle complicanze stomali e peristomali nei centri stomizzati della ASL11 di Empoli e ASL4 di Prato. Atti del congresso AIOSS 2013.
  43. Rolstad BS, Erwin Toth PL. Peristomal skin complications: prevention and management. Ostomy Wound Management 2004; 50(9): 68-77.
  44. Antonini Mario. Le complicanze della cute peristomale: assessment e trattamento infermieristico In: A.I.O.S.S. Arte e scienza dell’assistenza infermieristica in stomaterapia: curare, prendersi cura, educare, a cura di Carla Saracco. Castellato (TE): Editpress S.r.l.; luglio 2021; 563-585
  45. Antonini M, Militello G. Nursing management of a viscerocutaneous fistula. WCET Journal. 2012; 32(1):26-32.
  46. M. Gray, JC Colwell, D. Doughty, et al. Peristomal moisture associated skin demage in adult with fecal ostomies: a comprehensive review and consensus. J Wound Ostomy Continennce Nurs. 2013; 40(4):389-399.
  47. Cottam et al. Results of nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Disease. 2007; 9(9); 834-838.
  48. Ndlovu S. The complication of mucocutaneous separation after stoma surgery. Gastrointestinal Nursing. 2015; 13(2):23-30.
  49. Gray M, LeBlanc K, Whiteley I, McNichol L, Salvadalena G. Peristomal Medical Adhesive–Related Skin Injury. Results of an International Consensus Meeting. J Wound Ostomy Continence Nurs. 2019;46(2):125-136.
  50. McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science: consensus statements for the assess¬ment, prevention, and treatment of adhesive-related skin injuries. J Wound Ostomy Continence Nurs. 2013;40(4):365-380.
  51. Angriman I, Buzzi G, Giorato E, Barbierato M, Cavallin F, Ruffolo C, Degasperi S, Mari V, De Simoni O, Campi M, Zingales F, Roveron G, Iafrate M, Pucciarelli S, Bardini R, Scarpa M. Crohn's Disease-Related Stoma Complications and Their Impact on Postsurgical Course. Dig Surg. 2022;39(2-3):83-91. doi: 10.1159/000524036. Epub 2022 Mar 16. PMID: 35294945.nye
  52. Nybaek H, Bang Knudsen D, Nørgaard Laursen T, Karlsmark T, Jemec GB. Skin problems in ostomy patients: a case-control study of risk factors. Acta Derm Venereol. 2009;89(1):64-7. doi: 10.2340/00015555-0536. PMID: 19197544.
  53. C.C. Lyon, A.J. Smith, C.E.M. Griffiths, M.H. Beck, The spectrum of skin disorders in abdominal stoma patients, British Journal of Dermatology, Volume 143, Issue 6, 1 December 2000, Pages 1248–1260, https://doi.org/10.1046/j.1365-2133.2000.03896.x
  54. Borglund E, Nordström G, Nyman CR. Classification of peristomal skin changes in patients with urostomy. J Am Acad Dermatol. 1988 Oct;19(4):623-8. doi: 10.1016/s0190-9622(88)70215-7. PMID: 3053801.
  55. Jemec GB, Martins L, Claessens I, Ayello EA, Hansen AS, Poulsen LH, Sibbald RG. Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool. Br J Dermatol. 2011 Feb;164(2):330-5. doi: 10.1111/j.1365-2133.2010.10093.x. PMID: 20973766.
  56. Bosio G, Fonti A, Pisani F, Scrocca A, et al. Studio osservazionale multicentrico sulle alterazioni cutanee post-enterostomie (SACS). Classificazione delle alterazioni peristomali. G Chir. 2006; 27:251-4.
  57. Antonini M, Arena R, Gasperini S, Manfredda S, Militello G, Veraldi S. A revised version of the original SACS Scale for Peristomal Skin Disorders Classification. WCET J. 2016; 36:22-29.
  58. Menin G, Roveron G, Barbierato M, Peghetti A, Zanotti R. Design and validation of a "Peristomal Lesion Scale" for peristomal skin assessment. Int Wound J. 2019 Apr;16(2):433-441. doi: 10.1111/iwj.13052. Epub 2018 Dec 13. PMID: 30548924; PMCID: PMC7949408.