A total of 1131 patients with loop enterostomy in six studies were included in this study; there were 569 cases in the experimental group and 562 cases in the control group. All six studies analyzed the effect of support rods on the incidence of stoma retraction; the meta-analysis showed that in a total of 32 patients, stoma retraction occurred, with a total incidence of about 2.8% in 1131 patients. The incidence of stoma retraction in the rod group was not significantly lower than that in the non-rod group, and the difference was not statistically significant (OR = 0.65, 95% CI 0.32~1.32, I 2 = 0%, P = 0.23), and the studies were homogeneous. The incidences of stoma necrosis (OR = 6.41, 95% CI 2.22~18.55, I 2 = 0%, P = 0.0006), peristomal dermatitis (OR = 2.93, 95% CI 2.01~4.27, I 2 = 0%, P< 0.00001), and mucocutaneous separation (OR = 2.14, 95% CI 1.03~4.47, I 2 = 0%, P = 0.04) were significantly increased in the rod group. Conclusions

The purpose of the systematic review and meta-analysis is to analyze the application value of the stoma support rods in loop enterostomy. Methods Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP. Stoma complications: a multivariate analysis. Am Surg. 2002;68:961–6; discussion 966. Oh HK, et al. Is the use of a support bridge beneficial for preventing stomal retraction after loop ileostomy? A Prospective Nonrandomized Study. J Wound Ostomy Continence Nurs. 2015;42:368–73. https://doi.org/10.1097/won.0000000000000131.Robertson I, et al. Prospective analysis of stoma-related complications. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2005;7:279–85. https://doi.org/10.1111/j.1463-1318.2005.00785.x.

Baloyiannis I, et al. Loop stomas with a subcutaneously placed bridge device. Tech Coloproctol. 2010;14(Suppl 1):S75–6. https://doi.org/10.1007/s10151-010-0627-7.

Cochrane RA, Hay DJ, Jones AF. A better bridge for loop stomas. The British journal of surgery. 1996;83:365. https://doi.org/10.1002/bjs.1800830322. The studies on the application of stoma rods in loop enterostomy published from January 2000 to January 2020 were searched in the databases of PubMed, Embase, Cochrane library, and Clinical trials. All randomized controlled trials (RCTs) and cohort studies that observed the value of stoma rods were included according to inclusion criteria. The RevMan5.3 software was used for statistical analysis. Results Butler DL. Early postoperative complications following ostomy surgery: a review. J Wound Ostomy Continence Nurs. 2009;36:513–9; quiz 520-511. https://doi.org/10.1097/WON.0b013e3181b35eaa. Zindel J, et al. A sustaining rod increases necrosis of loop ileostomies: a randomized controlled trial. International journal of colorectal disease. 2017;32:875–81. https://doi.org/10.1007/s00384-017-2813-9. Uchino M, et al. Is an ostomy rod useful for bridging the retraction during the creation of a loop ileostomy? A randomized control trial. World J Surg. 2017;41:2128–35. https://doi.org/10.1007/s00268-017-3978-7.

Harish K. The loop stoma bridge--a new technique. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2008;12:958–61. https://doi.org/10.1007/s11605-007-0413-7. At present, the details of the use of stoma support rods are not unified in different countries and regions, and there are all kinds of support rods, especially for the placement time, there is still no conclusion. It is reported that the retention time of the support rods in different medical centers is different; most of which are placed for 5 to 7 days [ 15, 16, 17], some for 7 to 14 days [ 18, 19], or even 3 to 4 weeks [ 20, 21] later. There is currently no literature to show the effect of placement time of support rods on the incidence of stoma retraction. It was reported that the incidence of stoma retraction was about 0 to 1.4% [ 22, 23, 24, 25], and support rods were routinely used in these studies. In contrast, some studies have reported a high retraction rate of stoma, about 5 to 26% [ 20, 26, 27], or even as high as 40% [ 28]. However, there are great differences in the population of these studies, some only include ileostomy, or some only include colostomy, which may be an important reason for the difference in statistical data. Besides, the definition of retraction is not unique. Some studies define stoma mucosa below the skin as retraction [ 5], while other studies require mucosa to be at least 0.5 cm below the skin surface to diagnose retraction [ 29], so different definitions used in different studies may also lead to differences in the incidence of stoma retraction. Nowadays, this meta-analysis showed that of the 1131 patients included, 32 had stoma retraction (2.8%), the overall contraction rate was very low, and there was no statistical difference in the incidence of stoma retraction between the rod group and the non-rod group. Jenkinson LR, Houghton PW, Steele KV, Donaldson LA, Crumplin MK. The Biethium bridge--an advance in stoma care. Ann R Coll Surg Engl. 1984;66:420–2. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2010;12:958–64. https://doi.org/10.1111/j.1463-1318.2009.02006.x.Arumugam PJ, et al. A prospective audit of stomas--analysis of risk factors and complications and their management. Colorectal Dis. 2003;5:49–52. https://doi.org/10.1046/j.1463-1318.2003.00403.x. Odds ratio (OR), weight mean difference (WMD), and standardized mean difference (SMD) presented with 95% confidence interval (CI) were used to pool analysis dichotomous and continuous variables, respectively. The difference was statistically significant when the P value was less than 0.05. Speirs M, et al. Ileostomy rod--is it a bridge too far? Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2006;8:484–7. https://doi.org/10.1111/j.1463-1318.2005.00923.x.

It was not specified length of the rod that has been placed in the study of Zindel et al. [ 13]. The duration of rod use was short being only 3.5 days in the study of Whiteley et al. [ 11], but in another two studies [ 9, 14], the rod was removed on the 7–8th day after surgery, while in the RCT performed by Franklyn et al. [ 12], the rod was left in place until the 10–14th day after surgery, and even more, according to the study of Oh et al. [ 10], the rod was braced until the 4–28th day after surgery. Pisarska M, et al. Defunctioning ileostomy reduces leakage rate in rectal cancer surgery - systematic review and meta-analysis. Oncotarget. 2018;9:20816–25. https://doi.org/10.18632/oncotarget.25015. Merrett ND, Gartell PC. A totally diverting loop colostomy. Annals of the Royal College of Surgeons of England. 1993;75:272–4.

Fitzgibbons RJ Jr, Schmitz GD, Bailey RT Jr. A simple technique for constructing a loop enterostomy which allows immediate placement of an ostomy appliance. Surg Gyneco Obstet. 1987;164:78–80. And meanwhile, an observational cohort study of Whiteley et al. [ 11] showed that 91.4% of enterostomies used support rods in 2003, while in 2012, only 10% of enterostomies used rods to prevent retraction, and in the process of significant reduction in the use of stoma support bars, the incidence of retraction did not change significantly, which also proved from the side that the occurrence of stoma retraction was not significantly related to the use of support rods. Whiteley I, Russell M, Nassar N, Gladman MA. Outcomes of support rod usage in loop stoma formation. International journal of colorectal disease. 2016;31:1189–95. https://doi.org/10.1007/s00384-016-2569-7.