Abstract
Background
Stoma rods are used traditionally to prevent retraction of loop stomas into the abdominal cavity. However, there is very little evidence to support or refute their use. The aim of the present systematic review and metaanalysis was to assess the current data on stoma rods in loop stomas. The primary outcomes were stoma necrosis and stoma retraction.
Methods
A systematic review and metaanalyses were conducted using the preferred reporting items for systematic reviews and metaanalysis guidelines (PRISMA). The study protocol was registered prospectively on PROSPERO. An electronic search was performed by two reviewers independently using predefined search strategy and Medline. Bibliographies of selected studies were screened for additional references. RevMan was used to generate forest plots and calculate odds ratios and 95% confidence intervals (CIs).
Results
In total, five studies were identified that met inclusion criteria, including four randomized controlled trials. Three studies examined only ileostomies, while one included both colostomies and ileostomies, and one only examined colostomies. In total, 561 patients underwent a stoma with a rod compared to 443 without. There was a higher rate of dermatitis (rod 29.86% vs no rod 16% OR 2.65; 95% CI 1.79–3.93) and stoma necrosis (rod 7% vs no rod 1.15% OR 5.58; 95% CI 1.85–16.84) in the rod group, but there was no significant difference in stoma retraction (rod 2.28% vs no rod 3.45%; OR 0.7; 95% CI 0.32–1.54).
Conclusions
Stoma rods do not reduce the incidence of stoma retraction and instead lead to increased rates of dermatitis and stoma necrosis.
Similar content being viewed by others
References
Dehni N, Schlegel RD, Cunningham C, Guiguet M, Tiret E, Parc R (1998) Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg 85(8):1114–1117
Doughty DB (2008) History of ostomy surgery. J Wound Ostomy Cont Nurs 35(1):34–38
Brooke B (1952) The management of an ileostomy including its complications. Lancet 2:102–104
Malik T, Lee MJ, Harikrishnan AB (2018) The incidence of stoma related morbidity—a systematic review of randomised controlled trials. Ann R Coll Surg Engl 100(7):501–508
McNair AGK, Whistance RN, Forsythe RO, Rees J, Jones JE, Pullyblank AM, Avery KNL, Brookes ST, Thomas MG, Sylvester PA, Russell A, Oliver A, Morton D, Kennedy R, Jayne DG, Huxtable R, Hackett R, Dutton SJ, Coleman M, Card M, Brown J, Blazeby JM (2015) Synthesis and summary of patient-reported outcome measures to inform the development of a core outcome set in colorectal cancer surgery. Colorectal Dis 17(11):O217–O229
Zindel J, Gygax C, Studer P, Kauper M, Candinas D, Banz V, Brügger LE (2017) A sustaining rod increases necrosis of loop ileostomies: a randomized controlled trial. Int J Colorectal Dis 32(6):875–881
Uchino M, Ikeuchi H, Bando T, Chohno T, Sasaki H, Horio Y (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(8):2128–2135
Franklyn J, Varghese G, Mittal R, Rebekah G, Jesudason MR, Perakath B (2017) A prospective randomized controlled trial comparing early postoperative complications in patients undergoing loop colostomy with and without a stomarod. Colorectal Dis 19(7):675–680
Whiteley I, Russell M, Nassar N, Gladman MA (2016) Outcomes of support rod usage in loop stoma formation. Int J Colorectal Dis 31(6):1189–1195
Speirs M, Leung E, Hughes D, Robertson I, Donnelly L, Mackenzie I, Macdonald A (2006) Ileostomy rod—is it a bridge too far? Colorectal Dis 8(6):484–487
Pisarska M, Gajewska N, Małczak P, Wysocki M, Witowski J, Torbicz G, Major P, Mizera M, Dembiński M, Migaczewski M, Budzyński A, Pędziwiatr M (2018) Defunctioning ileostomy reduces leakage rate in rectal cancer surgery—systematic review and meta-analysis. Oncotarget 9(29):20816–20825. https://doi.org/10.18632/oncotarget.25015 (eCollection 2018 Apr 17)
Wu X, Lin G, Qiu H, Xiao Y, Wu B, Zhong M (2018) Loop ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy. Eur J Med Res 23(1):24. https://doi.org/10.1186/s40001-018-0325-x
Oh HK, Han EC, Song YS, Seo MS, Ryoo SB, Jeong SY, Park KJ (2015) Is the use of a support bridge beneficial for preventing stomal retraction after loop ileostomy? A prospective nonrandomized study. J Wound Ostomy Cont Nurs 42(4):368–373
Dziki Ł, Mik M, Trzciński R, Buczyński J, Darnikowska J, Spychalski M, Wierzbicka A, Dziki A (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 Przegl Chir 87(1):31–34. https://doi.org/10.1515/pjs-2015-0014
Goldstein ET, Williamson PR (1993) A more functional loop ileostomy rod. Dis Colon Rectum 36(3):297–298
Shabbir J, Britton DC (2010) Stoma complications: a literature overview. Colorectal Dis 12(10):958–964
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
As this was a systematic review and metaanalyses of existing studies ethical approval was not required.
Informed consent
For this type of study formal consent is not required.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Mohan, H.M., Pasquali, A., O’Neill, B. et al. Stoma rods in abdominal surgery: a systematic review and metaanalyses. Tech Coloproctol 23, 201–206 (2019). https://doi.org/10.1007/s10151-019-01935-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-019-01935-w