Comparative effectiveness of modified ileostomy techniques in rectal cancer surgery: A systematic review and network meta-analysis
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Published on: February 12, 2022
Xueqin Wang1, Zhu Zhu2, Zhengqi Wen1
1Department of Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Background:
This systematic review and network meta-analysis evaluates the efficacy and safety of different ileostomy methods (conventional, 1-stitch, modified 1-stitch, prolapse technique + 1-stitch, and modified 2-stitch) in ileostomy and stoma reversal surgery and ranks their effectiveness.
Methods:
We searched 8 databases (PubMed, Cochrane, Embase, Web of Science, CNKI, Wanfang, VIP, and SinoMed) from inception to December 2025. Interventions included 1-stitch, prolapse + 1-stitch, modified 1-stitch, continuous intradermal suture, modified 2-stitch, simple support + 1-stitch, 3-stitch, and 2-stitch.
Results:
A total of 16 studies (1,402 patients, 9 interventions) were included. Different ileostomy methods showed differential advantages across clinical indicators. Continuous intradermal suture significantly shortened total ileostomy duration and reduced stoma retraction. Prolapse surgery + 1-stitch was associated with shorter phase I hospitalization and stoma exhaust time. Simple support bracket + 1-stitch was associated with less blood loss during reversal surgery. One-stitch shortened the interval of reversal surgery and the length of hospitalization postreversal surgery. Modified 2-stitch was associated with a lower incidence of overall complications. Three-stitch + innovative knotting effectively prevented stoma stenosis and skin-mucosal separation, whereas 3-stitch alone prevented stoma prolapse. No statistically significant differences were observed for intraoperative blood loss, parastomal hernia, irritant dermatitis, stoma infection, or ischemia/necrosis.
Conclusion:
Modified ileostomy techniques appear better than conventional methods in surgical efficiency, postoperative recovery, and complication control. Continuous intradermal suture is associated with shorter operative duration. The 1-stitch technique and its derivatives promote postoperative recovery. Multistitch techniques are better at preventing stoma prolapse and stenosis. However, because of the absence of closed loops in the evidence network and the predominantly retrospective study design, these findings may be overestimated.
