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

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


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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Demography
  • Endpoint Determination
  • Female
  • Humans
  • Ileostomy*
  • Male
  • Middle Aged
  • Necrosis / etiology*
  • Quality of Life
  • Surgical Stomas