Rod in loop ileostomy: just an insignificant detail for ileostomy-related complications?
OBJECTIVE
The aim of this prospective study was to validate a variant in the loop ileostomy construction to reduce peristomal pressure ulcers and, subsequently, the need of stoma therapist assistance and the frequency of changing the stoma appliance.


METHODS
We have enrolled 33 consecutive patients who underwent two stage restorative proctocolectomies. The first consecutive 13 patients operated on had their ileostomies constructed with a standard rod. In the following 20 patients, we placed a 5.3-mm suction catheter tube closed with a stitch to form a "ring" and without any stitches fixing it to the skin.


RESULTS
In the "ring" rod group 40% of patients did not report any complication compared to the 8% of patients in the standard rod group (p = 0.046). Pressure ulcers were absent in this group, while it affected 61% of the patients in the standard rod group (p < 0.001). Patients in the "ring" rod group needed significantly less assistance time by the stoma therapist (p < 0.01) and required significantly fewer stoma appliance changes (p < 0.01). In our institution, the overall cost for the complete management of a standard rod ileostomy was 73.16 (29.83-130.49) euro compared to 46.65 (23.15-93.48) euro for a "ring" rod ileostomy (p = 0.002).


CONCLUSIONS
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.
Scarpa
Marco
M
Department of Surgical and Gastroenterological Science, Sezione di Clinica Chirurgica I, University of Padova, Padova, Italy. marcoscarpa73@yahoo.it
Sadocchi
Laura
L
Ruffolo
Cesare
C
Iacobone
Maurizio
M
Filosa
Teresa
T
Prando
Daniela
D
Polese
Lino
L
Frego
Mauro
M
D'Amico
Davide F
DF
Angriman
Imerio
I
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D003668:Pressure Ulcer / Q000517:prevention & control; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D054047:Surgical Stomas