Rod in loop ileostomy: just an insignificant detail for ileostomy-related complications?

Abstract

The adoption of a "ring" rod configuration led to an elimination of pressure ulcers due to the rigid rod, a shorter time requirement for stoma care and a decreased number of appliances required and was subsequently associated with lower costs of assistance. A tighter fitting around the ileostomy that avoided stool infiltration improved the practical management of the stoma with a "ring" rod.

Intestinal Surgery for Crohn’s Disease: Predictors of Recovery, Quality of Life, and Costs

“…Moreover, median sick leave seemed to be longer in patients who had a stoma created even if at multiple regression analysis only the physical burden of the job independently predicted sick leave duration. Curiously, although stoma creation was clearly associated with a slower recovery and it took time for patients to adapt to the new body situation, 25 it did not predict poor quality of life. In fact, although this concern has been rated among the most important factors in other studies of patients with CD, 26,27 in our series an ostomy bag did not seem to influence the early postoperative quality of life.…”

Diverting loop ileostomy after restorative proctocolectomy: predictors of poor outcome and poor quality of life

“…Both conditions produce a less than perfect adhesion of the appliance to the skin and the liquid and slightly caustic stool can therefore make contact with the peristomal skin, thereby irritating it. As already demonstrated in a previous study, the use of a 'ring' rod, routinely adopted only since 2005, minimizes the risk of stool leak, provides a better adhesion to the skin and avoids the onset of dermal lesion because of decubitus [16]. On the contrary, retraction appears to be an unpredictable complication as none of the analysed parameters were shown to be related to it.…”

“…Even if some authors report an overall low rate of postoperative complications [13], the morbidity rate of diverting loop ileostomy reported reaches 40% in recent studies [10,11]. Even minor complications, such as peristomal dermatitis, need extra medical care that may significantly affect the quality of life (QOL) of the patients [14,15] and may significantly increase the management costs of the procedure [16]. Furthermore, because of the major change in physical appearance and bodily function, patients with a stoma are challenged with a number of QOL issues [17].…”

“…The ileal loop was then delivered through a trephine in the abdominal wall by placing a tape under the mesenteric margin between the ileum and the marginal arcade. A 5.3-mm suction catheter tube closed with a stitch in order to create a 'ring' and without stitches fixing it to the skin or a plastic rigid rod ('standard') fixed to the skin with a pair of 0 polypropylene stitches were placed on the skin under the ileal loop [16]. After closure of the laparotomy, the ileostomy was opened and the proximal component of loop everted and then fixed to the skin with muco-cutaneous absorbable 3-0 polyglactine sutures.…”

Ileostomy

“…The use of a "ring" rod is also an option to avoid pressure ulcers and limit the need for stoma care nursing assistance. 9 However, others do not consider a rod mandatory when the ileal loop is easily exteriorized. 3,10 In a randomized series of 60 patients comparing "bridge" or "bridgeless" loop ileostomies, no difference in the retraction rate was observed between the two groups.…”