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Outcomes of support rod usage in loop stoma formation

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

Traditionally, support rods have been used when creating loop stomas in the hope of preventing retraction. However, their effectiveness has not been clearly established. This study aimed to investigate the rate of stoma rod usage and its impact on stoma retraction and complication rates.

Method

A prospective cohort of 515 consecutive patients who underwent loop ileostomy/colostomy formation at a tertiary referral colorectal unit in Sydney, Australia were studied. Mortality and unplanned return to theatre rates were calculated. The primary outcome measure of interest was stoma retraction, occurring within 30 days of surgery. Secondary outcome measures included early stoma complications. The 10-year temporal trends for rod usage, stoma retraction, and complications were examined.

Results

Mortality occurred in 23 patients (4.1 %) and unplanned return to theatre in 4 patients (0.8 %). Stoma retraction occurred in four patients (0.78 %), all without rods. However, the rate of retraction was similar, irrespective of whether rods were used (P = 0.12). There was a significant decline in the use of rods during the study period (P < 0.001) but this was not associated with an increase in stoma retraction rates. Early complications occurred in 94/432 patients (21.8 %) and were more likely to occur in patients with rods (64/223 versus 30/209 without rods, P < 0.001).

Conclusions

Stoma retraction is a rare complication and its incidence is not significantly affected by the use of support rods. Further, complications are common post-operatively, and the rate appears higher when rods are used. The routine use of rods warrants judicious application.

What does this paper add to the literature?

It remains unclear whether support rods prevent stoma retraction. This study, the largest to date, confirms that stoma retraction is a rare complication and is not significantly affected by the use of rods. Consequently, routine rod usage cannot be recommended, particularly as it is associated with increased stoma complications.

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References

  1. Morris E, Quirke P, Thomas JD, Fairley L, Cottier B, Forman D (2008) Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene? Gut 57(12):1690–7

    Article  CAS  PubMed  Google Scholar 

  2. Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ (2010) Complications of intestinal stomas. Br J Surg 97(12):1885–9

    Article  CAS  PubMed  Google Scholar 

  3. Goldstein ET, Williamson PR (1993) A more functional loop ileostomy rod. Dis Colon Rectum 36(3):297–8

    Article  CAS  PubMed  Google Scholar 

  4. Butler DL (2009) Early postoperative complications following ostomy surgery: a review. J Wound Ostomy Continence Nurs 36(5):513–9, quiz 20–1

    Article  PubMed  Google Scholar 

  5. Kann BR (2008) Early stomal complications. Clin Colon Rectal Surg 21(1):23–30

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cheape JD, Hooks VH (1994) Loop ileostomy: a reliable method of diversion. South Med J 87(3):370–4

    Article  CAS  PubMed  Google Scholar 

  7. Langenbach MR, Sauerland S, Issa E, Nitschke C, Zirngibl H (2011) Loop ileostomy and colostomy—a comparison between supporting plastic rods and epicutaneous or subcutaneous silicon drains. Surg Sci 2:252–6

  8. Cottam J, Richards K, Hasted A, Blackman A (2007) Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis 9(9):834–8

    Article  CAS  PubMed  Google Scholar 

  9. Burch J (2004) The management and care of people with stoma complications. Br J Nurs 13(6):307–8, 10, 12, 14–8

    Article  PubMed  Google Scholar 

  10. Arumugam PJ, Bevan L, Macdonald L, Watkins AJ, Morgan AR, Beynon J et al (2003) A prospective audit of stomas—analysis of risk factors and complications and their management. Colorectal Dis 5(1):49–52

    Article  CAS  PubMed  Google Scholar 

  11. Speirs M, Leung E, Hughes D, Robertson I, Donnelly L, Mackenzie I et al (2006) Ileostomy rod—is it a bridge too far? Colorectal Dis 8(6):484–7

    Article  CAS  PubMed  Google Scholar 

  12. Aitken RJ, Stevens PJ, du Preez N, Elliot MS (1986) Raising a colostomy—results of a prospective surgical audit. Int J Colorectal Dis 1(4):244–7

    Article  CAS  PubMed  Google Scholar 

  13. Cronin E (2010) An overview of stoma bridges and a case study on their management. Br J Nurs 19(17):S16–S20

    Article  PubMed  Google Scholar 

  14. Lafreniere R, Ketcham AS (1985) The Penrose drain: a safe, atraumatic colostomy bridge. Am J Surg 149(2):288–91

    Article  CAS  PubMed  Google Scholar 

  15. Harish K (2008) The loop stoma bridge—a new technique. J Gastrointest Surg 12(5):958–61

    Article  CAS  PubMed  Google Scholar 

  16. Liu J, Bruch HP, Farke S, Nolde J, Schwandner O (2005) Stoma formation for fecal diversion: a plea for the laparoscopic approach. Tech Coloproctol 9(1):9–14

    Article  CAS  PubMed  Google Scholar 

  17. Wexner SD, Taranow DA, Johansen OB, Itzkowitz F, Daniel N, Nogueras JJ et al (1993) Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum 36(4):349–54

    Article  CAS  PubMed  Google Scholar 

  18. Byrne BE, Mamidanna R, Vincent CA, Faiz O (2013) Population-based cohort study comparing 30- and 90-day institutional mortality rates after colorectal surgery. Br J Surg 100(13):1810–7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Schootman M, Lian M, Pruitt SL, Hendren S, Mutch M, Deshpande AD et al (2014) Hospital and geographic variability in two colorectal cancer surgery outcomes: complications and mortality after complications. Ann Surg Oncol 21(8):2659–66

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Scarpa M, Ruffolo C, Boetto R, Pozza A, Sadocchi L, Angriman I (2010) Diverting loop ileostomy after restorative proctocolectomy: predictors of poor outcome and poor quality of life. Colorectal Dis 12(9):914–20

    Article  CAS  PubMed  Google Scholar 

  21. Baloyiannis I, Christodoulidis G, Symeonidis D, Hatzinikolaou I, Spyridakis M, Tepetes K (2010) Loop stomas with a subcutaneously placed bridge device. Tech Coloproctol 14(Suppl 1):S75–6

    Article  PubMed  Google Scholar 

  22. Branco AM, Saraiva AC (2009) Loop colostomy with a suprafascial bridge device. Dig Surg 26(4):282–4

    Article  PubMed  Google Scholar 

  23. Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP (2002) Stoma complications: a multivariate analysis. Am Surg 68(11):961–6, discussion 6

    PubMed  Google Scholar 

  24. Scarpa M, Sadocchi L, Ruffolo C, Iacobone M, Filosa T, Prando D et al (2007) Rod in loop ileostomy: just an insignificant detail for ileostomy-related complications? Langenbecks Arch Surg 392(2):149–54

    Article  PubMed  Google Scholar 

  25. Robertson I, Leung E, Hughes D, Spiers M, Donnelly L, Mackenzie I et al (2005) Prospective analysis of stoma-related complications. Colorectal Dis 7(3):279–85

    Article  CAS  PubMed  Google Scholar 

  26. Kim JT, Kumar RR (2006) Reoperation for stoma-related complications. Clin Colon Rectal Surg 19(4):207–12

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hollinworth H, Howlett S, Tallett J, Pettitt S, Cooper D, Skingley S et al (2004) Professional holistic care of the person with a stoma: online learning. Br J Nurs 13(21):1268–75

    Article  CAS  PubMed  Google Scholar 

  28. Atkinson SW, Bentley PG (1996) Subcutaneous bridge support for defunctioning loop colostomy. Br J Surg 83(10):1458

    Article  CAS  PubMed  Google Scholar 

  29. Nunoo-Mensah JW, Chatterjee A, Khanwalkar D, Nasmyth DG (2004) Loop ileostomy: modification of technique. Surgeon 2(5):287–91

    Article  CAS  PubMed  Google Scholar 

  30. Jenkinson LR, Houghton PW, Steele KV, Donaldson LA, Crumplin MK (1984) The Biethium bridge—an advance in stoma care. Ann R Coll Surg Engl 66(6):420–2

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Fitzgibbons RJ Jr, Schmitz GD, Bailey RT Jr (1987) A simple technique for constructing a loop enterostomy which allows immediate placement of an ostomy appliance. Surg Gynecol Obstet 164(1):78–80

    PubMed  Google Scholar 

  32. Merrett ND, Gartell PC (1993) A totally diverting loop colostomy. Ann R Coll Surg Engl 75(4):272–4

    CAS  PubMed  PubMed Central  Google Scholar 

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Supportive foundations

A/Prof. Natasha Nassar is supported by an Australian National Health and Medical Research Council (NHMRC) Career Development Fellowship (#632955).

Author information

Authors and Affiliations

  1. Academic Colorectal Unit, Sydney Medical School, University of Sydney, 1st Floor Clinical Sciences Building, Building 20, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia

    Ian Whiteley & Marc A. Gladman

  2. Department of General Surgery, Middlemore Hospital, Middlemore, New Zealand

    Michael Russell

  3. Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia

    Natasha Nassar

Authors
  1. Ian Whiteley
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  2. Michael Russell
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  3. Natasha Nassar
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  4. Marc A. Gladman
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Corresponding author

Correspondence to Marc A. Gladman.

Ethics declarations

This study was approved by the Sydney Local Health District Human Research Ethics Committee—Concord Repatriation General Hospital.

Conflicts of interests

No conflicts of interest exist.

Authors’ contributions

• Ian Whiteley developed the research question, collected data and maintained the stomal therapy database, applied to Human Research Ethics Committee for study approval, conducted the literature review and contributed to data analysis and writing/reviewing the final manuscript.

• Michael Russell conducted preliminary data analysis and review of final data, as well as reviewing the final manuscript.

• Assoc. Professor Natasha Nassar contributed to analysis of data, as well as writing and reviewing the final manuscript.

• Prof. Marc Gladman was involved in project conception/design and data interpretation, as well as writing and reviewing the final manuscript.

Additional information

Presentation

This work was delivered in part as a podium presentation at the Australian Association of Stomal Therapy Nurses 39th National Conference (20–22 March, 2013) in Hobart, Tasmania, Australia.

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Whiteley, I., Russell, M., Nassar, N. et al. Outcomes of support rod usage in loop stoma formation. Int J Colorectal Dis 31, 1189–1195 (2016). https://doi.org/10.1007/s00384-016-2569-7

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  • DOI: https://doi.org/10.1007/s00384-016-2569-7

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