title: A prospective randomized controlled trial comparing early postoperative complications in patients undergoing loop colostomy with and without a stoma rod.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery Unit 2 (Colorectal Surgery), Christian Medical College, Vellore, India.
authors.forename: J
authors.initials: J
authors.lastname: Franklyn
authors.affiliation: Department of Surgery Unit 2 (Colorectal Surgery), Christian Medical College, Vellore, India.
authors.forename: G
authors.initials: G
authors.lastname: Varghese
authors.affiliation: Department of Surgery Unit 2 (Colorectal Surgery), Christian Medical College, Vellore, India.
authors.forename: R
authors.initials: R
authors.lastname: Mittal
authors.affiliation: Department of Biostatistics, Christian Medical College, Vellore, India.
authors.forename: G
authors.initials: G
authors.lastname: Rebekah
authors.affiliation: Department of Surgery Unit 2 (Colorectal Surgery), Christian Medical College, Vellore, India.
authors.forename: M R
authors.initials: MR
authors.lastname: Jesudason
authors.affiliation: Dr Gray's Hospital, Elgin, UK.
authors.forename: B
authors.initials: B
authors.lastname: Perakath
mesh_terms: D000328:Adult; D003125:Colostomy / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D054047:Surgical Stomas / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Colostomy; colostomy rod; stomal retraction; supporting bridge