New classification of intestinal stomas and complications OLID (Occasio, Locus, Inpedimenta, Date)

Introduction. Currently, there is a constant increase in the number of patients who have undergone intestinal stoma surgery due to various diseases, developmental abnormalities or intestinal injuries. At the same time, there is no unified classification of intestinal stomas and their complications, and difficulties arise in making a uniform diagnosis, standardizing documentation, choosing treatment tactics, and continuity between outpatient and inpatient care is not ensured.

Aim. To develop and propose a unified classification of intestinal stomas and parastomal complications to standardize and improve the ability to compare different studies and their results. To make this classification useful, we decided that abstract and understandable abbreviations in the common medical language – Latin – should be used.

Materials and methods. Based on a literature review and critical assessment of existing classifications, they were revised in terms of the number of different sections, relevance, accuracy and simplicity. Outpatient and inpatient physicians must fill out data sets in a uniform manner, which is simplified by modern medical computer programs. The classification uses abstract and understandable abbreviations in the generally accepted medical language – Latin.

Results. The classification is designed for use in clinical and scientific practice, with the aim of improving surgical planning (choice of treatment method, time and method of surgery) and patient care. The proposed classification consists of 4 sections. All patients must initially be considered for reconstructive and restorative operations to close the intestinal stoma. This is section I (Occasio). In Section II, it is necessary to indicate the section of the intestine that is the stoma (Locus). In Section III, we suggest indicating complications of the formed intestinal stoma and peristomal skin complications (Inpedimenta). And in the last IV subsection, we suggest indicating the date (Date) of the formation of the intestinal stoma.

Conclusion. The OLID classification of intestinal stomas and complications can provide sufficient information to establish registries and can be used to compare studies on their treatment and its results. Due to its simplicity and clarity, it will help surgeons formulate an accurate description of the pathology. The proposed classification should be tested and validated in clinical practice. The testing process may provide new information that will allow us to consider future modifications of the classifications.

1. Babakhanlou R, Larkin K, Hita AG, Stroh J, Yeung SC. Stoma-related complications and emergencies. Int J Emerg Med. 2022;15(1):17. https://doi.org/10.1186/s12245-022-00421-9.

2. Шелыгин ЮА, Ачкасов СИ, Балобина ЭВ, Васильев СВ, Григорьев ЕГ, Голубева МЮ и др. Клинические рекомендации по ведению взрослых пациентов с кишечной стомой. М.; 2013. 33 с. Режим доступа: https://astom.ru/sites/default/files/recommendation_stoma_0.pdf.

3. Aboulian A. Ostomy complications in Crohn’s disease. Clin Colon Rectal Surg. 2019;32(4):314–322. https://doi.org/10.1055/s-0039-1683924.

4. Pearson R, Knight SR, Ng JCK, Robertson I, McKenzie C, Macdonald AM. Stoma-related complications following ostomy surgery in 3 acute care hospitals. J Wound Ostomy Continence Nurs. 2020;47(1):32–38. https://doi.org/10.1097/WON.0000000000000605.

5. Shabbir J, Britton DC. Stoma complications: aliterature overview. Color Dis. 2010;12(10):958–964. https://doi.org/10.1111/j.1463-1318.2009.02006.x.

6. Robertson I, Leung E, Hughes D, Spiers M, Donnelly L, Mackenzie I, Macdonald A. Prospective analysis of stoma-related complications. Color Dis. 2005;7(3):279–285. https://doi.org/10.1111/j.1463-1318.2005.00785.x.

7. Park JJ, Del Pino A, Orsay CP, Nelson RL, Pearl RK, Cintron JR, Abcarian H. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum. 1999;42(12):1575–1580. https://doi.org/10.1007/BF02236210.

8. Persson E, Berndtsson I, Carlsson E, Hallén AM, Lindholm E. Stoma-related complications and stoma size – a 2-year follow up. Color Dis. 2010;12(10):971–976. https://doi.org/10.1111/j.1463-1318.2009.01941.x.

9. Simatov SA. Current problems of health care delivery and rehabilitation of patients with stoma. Bulletin of the Medical Institute “REAVIZ”: Rehabilitation, Doctor, and Health. 2017;(3):78–82. (In Russ.) Available at: https://elibrary.ru/zgchyf.

10. Śmietański M, Szczepkowski M, Alexandre JA, Berger D, Bury K, Conze J et al. European Hernia Society classification of parastomal hernias. Hernia. 2014;18(1):1–6. https://doi.org/10.1007/s10029-013-1162-z.

11. Brandsma HT, Hansson BM, Aufenacker TJ, van Geldere D, van Lammeren FM, Mahabier C et al. Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicentre randomized trial. Hernia. 2016;20(4):535–541. https://doi.org/10.1007/s10029-015-1427-9.

12. Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT et al. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia. 2018;22(1):183–198. https://doi.org/10.1007/s10029-017-1697-5.

13. Ibatullin AA, Aitova LR, Gainutdinov FM, Kulyapin AV, Timerbulatov МV. Reconstructive surgery of stomy complications. Bashkortostan Medical Journal. 2017;71(5):25–32. (In Russ.) Available at: https://mvb-bsmu.ru/files/journals/5_2017.pdf.

14. Szczepkowski M, Przywózka-Suwała A, Ziółkowski B, Witkowski P, Perea J. Hybrid parastomal hernia endoscopic repair (HyPER): novel approach to parastomal hernia surgery. Br J Surg. 2024;111(4):znae092. https://doi.org/10.1093/bjs/znae092.

15. Fleming AM, Phillips AL, Drake JA, Gross MG, Yakoub D, Monroe J et al. Sugarbaker Versus Keyhole Repair for Parastomal Hernia: a systematic review and Meta-analysis of comparative studies. J Gastrointest Surg. 2023;27(3):573–584. https://doi.org/10.1007/s11605-022-05412-y.