Journal article
A sustaining rod increases necrosis of loop ileostomies: a randomized controlled trial.
- Zindel J Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland.
- Gygax C Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland.
- Studer P Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland.
- Kauper M Department of Visceral Surgery, Kantonsspital Luzern, CH-6000 Luzern and Spital Tafers, CH-1712, Tafers, Switzerland.
- Candinas D Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland.
- Banz V Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland.
- Brügger LE Inselspital, University Hospital Bern and University of Bern, CH-3010, Bern, Switzerland. lukas.bruegger@insel.ch.
- 2017-04-19
Published in:
- International journal of colorectal disease. - 2017
Defunctioning stoma
Local stomal complications
Loop ileostomy
Sustaining rod
Demography
Endpoint Determination
Female
Humans
Ileostomy
Male
Middle Aged
Necrosis
Quality of Life
Surgical Stomas
English
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.
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.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1007/s00384-017-2813-9
- PMID 28417196
- Persistent URL
- https://sonar.ch/global/documents/140331
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