Skin bridge versus conventional rods for loop enterostomies: a systematic literature review and meta-analysis

Ostomy rods are used to prevent stoma-related morbidity. However, their effectiveness remains questionable, and to date, no standard technique has been recommended. We sought to identify the most suitable method by comparing skin bridge- and conventional rod-supported loop enterostomies.

In accordance with PRISMA guidelines, a systematic literature search was conducted in PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials, and Google Scholar databases for all comparative studies evaluating skin bridges and conventional ostomy rods. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for outcomes of both methods. Risk of bias and certainty of evidence were assessed using ROBINS-I and GRADE, respectively. The study protocol was registered in PROSPERO (ID: 420251028945).

A total of four eligible studies encompassing 323 patients were included (skin bridge: n = 155, control: n = 168). Loop ileostomies with a skin bridge were associated with significantly lower rates of peristomal dermatitis (OR = 0.13; 95% CI [0.06-0.29]; p < 0.00001, I² = 0%) and mucocutaneous separation (OR = 0.12; 95% CI [0.05-0.29]; p < 0.00001, I² = 0%) compared with conventional ostomy rods. Other analyzed outcomes, including parastomal hernia, ostomy prolapse, ostomy retraction, ostomy stenosis, and surgical site infection did not differ significantly between the two groups. Skin bridges appear to reduce the number of ostomy wafers replaced per week and overall ostomy-related costs.

Loop ileostomy creation with a skin bridge appears to be a safe and feasible method for preventing early ostomy-related morbidity.