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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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Author notes

  1. V.B. and L.B. contributed equally to this work.

Authors and Affiliations

  1. Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland

    Joel Zindel, Chantal Gygax, Peter Studer, Daniel Candinas, Vanessa Banz & Lukas E. Brügger

  2. Department of Visceral Surgery, Kantonsspital Luzern, CH-6000 Luzern and Spital Tafers, CH-1712, Tafers, Switzerland

    Melanie Kauper

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  1. Joel Zindel
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  2. Chantal Gygax
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Correspondence to Lukas E. Brügger.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Zindel, J., Gygax, C., Studer, P. et al. A sustaining rod increases necrosis of loop ileostomies: a randomized controlled trial. Int J Colorectal Dis 32, 875–881 (2017). https://doi.org/10.1007/s00384-017-2813-9

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