title: Outcomes of support rod usage in loop stoma formation.
abstract: OBJECTIVE
  Traditionally, support rods have been used when creating loop stomas in the hope of preventing retraction. However, their effectiveness has not been clearly established. This study aimed to investigate the rate of stoma rod usage and its impact on stoma retraction and complication rates.
  
  
  METHODS
  A prospective cohort of 515 consecutive patients who underwent loop ileostomy/colostomy formation at a tertiary referral colorectal unit in Sydney, Australia were studied. Mortality and unplanned return to theatre rates were calculated. The primary outcome measure of interest was stoma retraction, occurring within 30 days of surgery. Secondary outcome measures included early stoma complications. The 10-year temporal trends for rod usage, stoma retraction, and complications were examined.
  
  
  RESULTS
  Mortality occurred in 23 patients (4.1 %) and unplanned return to theatre in 4 patients (0.8 %). Stoma retraction occurred in four patients (0.78 %), all without rods. However, the rate of retraction was similar, irrespective of whether rods were used (P = 0.12). There was a significant decline in the use of rods during the study period (P < 0.001) but this was not associated with an increase in stoma retraction rates. Early complications occurred in 94/432 patients (21.8 %) and were more likely to occur in patients with rods (64/223 versus 30/209 without rods, P < 0.001).
  
  
  CONCLUSIONS
  Stoma retraction is a rare complication and its incidence is not significantly affected by the use of support rods. Further, complications are common post-operatively, and the rate appears higher when rods are used. The routine use of rods warrants judicious application. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: It remains unclear whether support rods prevent stoma retraction. This study, the largest to date, confirms that stoma retraction is a rare complication and is not significantly affected by the use of rods. Consequently, routine rod usage cannot be recommended, particularly as it is associated with increased stoma complications.
authors.affiliation: Academic Colorectal Unit, Sydney Medical School, University of Sydney, 1st Floor Clinical Sciences Building, Building 20, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Whiteley
authors.affiliation: Department of General Surgery, Middlemore Hospital, Middlemore, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Russell
authors.affiliation: Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Nassar
authors.affiliation: Academic Colorectal Unit, Sydney Medical School, University of Sydney, 1st Floor Clinical Sciences Building, Building 20, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia. m.a.gladman@sydney.edu.au.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Gladman
mesh_terms: D003710:Demography; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D054047:Surgical Stomas / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Complications; Loop colostomy; Loop ileostomy; Stoma; Support rods