Supporting or complicating? The role of rods and bridges in loop stomas: a comprehensive systematic review and meta-analysis with GRADE evaluation and trial sequential analysis

This systematic review and meta-analysis investigated the efficacy and safety of support rods and bridges in loop stoma formation, a practice frequently employed in colorectal surgery despite the associated complications and controversial efficacy. The aim of this study is to provide evidence-based guidance on their routine use. Adhering to the Cochrane Collaboration's recommendations, we conducted this systematic review and meta-analysis systematically searching PubMed, Scopus and Web of Science for randomized controlled trials (RCTs) evaluating the efficacy of rods/ bridges in loop ileostomies. Key outcomes assessed included stoma retraction, stoma/skin necrosis, peristomal dermatitis, infection, and mucocutaneous separation. This review included six studies encompassing 1,239 patients (195 ileostomy, 1,044 colostomy). Analysis revealed no statistically significant difference in stoma retraction (RR = 0.70, 95% CI [0.37 to 1.33], P = 0.28). Conversely, for stoma/skin necrosis, four studies were analyzed and showed a statistically significant difference favoring the non-rod/bridge group (RR = 5.04, 95% CI [1.72 to 14.73], P = 0.003). For peristomal dermatitis, three studies revealed a statistically significant difference favoring the non-rod/bridge group (RR = 2.01, 95% CI [1.55 to 2.60], P < 0.00001), with ostomy rod use identified as a significant risk factor (OR 3.42, p < 0.01). Outcomes for infection and mucocutaneous separation showed no significant difference. Based on the our results, routine rod/bridge use does not appear to reduce stoma retraction and may be associated with an increased risk of necrosis and dermatitis. That is why the routine use of rod/bridge does not appear to be justified, but the small number of the included studies limit the generalizability of these results. Trial sequential analysis indicated that future high-quality RCTs with diverse and larger populations and are recommended to obtain more rigorous evidence.