A prospective randomized controlled trial comparing early postoperative complications in patients undergoing loop colostomy with and without a stoma rod

• Published in: Colorectal disease 2017-07, Vol.19 (7), p.675-680
• Main Authors: Franklyn, J., Varghese, G., Mittal, R., Rebekah, G., Jesudason, M. R., Perakath, B.
• Format: Article
• Language: English
• Subjects: Adult; Clinical trials; Colostomy; Colostomy - adverse effects; Colostomy - instrumentation; Colostomy - methods; colostomy rod; Complications; Congestion; Construction; Edema; Exploration; Female; Gangrene; Humans; Intestine; Male; Middle Aged; Mucosa; Necrosis; Ostomy; Postoperative Complications - etiology; Prospective Studies; Randomization; stomal retraction; supporting bridge; Surgical Stomas - adverse effects; Treatment Outcome
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13600

Aim A stoma rod or bridge has been traditionally placed under the bowel loop while constructing a loop colostomy. This is believed to prevent stomal retraction and provide better faecal diversion. However, the rod can cause complications such as mucosal congestion, oedema and necrosis. This single‐centre prospective randomized controlled trial compared outcomes after creation of loop colostomy with and without a supporting stoma rod. The primary outcome studied was stoma retraction rate; other stoma‐related complications were studied as secondary outcomes. Method One hundred and fifty‐one patients were randomly allotted to one of two arms, colostomy with or without a supporting rod. Postoperative complications such as retraction, mucocutaneous separation, congestion and re‐exploration for stoma‐related complications were recorded. Results There was no difference in the stoma retraction rate between the two arms (8.1% in the rod arm and 6.6% in the no‐rod arm; P = 0.719). Stomal necrosis (10.7% vs 1.3%; P = 0.018), oedema (23% vs 3.9%; P = 0.001), congestion (20.3% vs 2.6%; P = 0.001) and re‐admission rates (8.5% vs 0%; P = 0.027) were significantly increased in the arm randomized to the rod. Conclusion The stoma rod does not prevent stomal retraction. However, complication rates are significantly higher when a stoma rod is used. Routine use of a stoma rod for construction of loop colostomy can be avoided.