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Int J Colorectal Dis. 2017 Jun;32(6):875-881. doi: 10.1007/s00384-017-2813-9. Epub 2017 Apr 18.

A sustaining rod increases necrosis of loop ileostomies: a randomized controlled trial.

Author information

1
Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland.
2
Department of Visceral Surgery, Kantonsspital Luzern, CH-6000 Luzern and Spital Tafers, CH-1712, Tafers, Switzerland.
3
Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland. lukas.bruegger@insel.ch.

Abstract

PURPOSE:

Defunctioning loop ileostomies (LI) are commonly used in colorectal surgery to reduce the potentially detrimental consequences of anastomotic leakages. However, stoma-related morbidity is high with up to 75% of patients having local complications. The aim of this study was to investigate the effect of a sustaining rod on the local complication rate.

METHODS:

In this prospective, multi-center, randomized controlled trial, subjects were allocated to either a rod or a rod-less protocol (NCT00959738). The primary outcome was local morbidity as measured by a stoma specific morbidity score (SSMS) during the first 3 months postoperatively.

RESULTS:

Between August 2008 and July 2014, a total of 122 patients were enrolled in the study, of which 78 (63.8%) completed the study [44 (56.4%) rod, 34 (43.6%) rod-less]. There was no significant difference in the SSMS between the two groups. The incidence of necrosis or partial necrosis, however, was significantly increased in the rod group: 13 (29.5%) vs. 1 (2.9%) in the rod-less group (p < 0.01). The retraction rate did not differ significantly between the groups: two (4.5%) in the rod vs. five (14.7%) in the rod-less group (p = 0.13). High body mass index (BMI > 26) was associated with an odds ratio of 5 (p < 0.01) for severe stoma complications.

CONCLUSIONS:

A rod-less technique for loop ileostomies reduces the risk of stomal necrosis, with a high BMI being an independent risk factor for stomal complications.

KEYWORDS:

Defunctioning stoma; Local stomal complications; Loop ileostomy; Sustaining rod

PMID:
28417196
DOI:
10.1007/s00384-017-2813-9
[Indexed for MEDLINE]

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