Application of the skin-bridge supported in-situ loop ileostomy in rectal cancer surgery

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To determine whether the skin-bridge supported in-situ loop ileostomy offers clinical advantages over the rod-supported method in the management of low rectal cancer, with the goal of guiding evidence-based clinical decision-making. A retrospective analysis was conducted on patients who underwent laparoscopic rectal cancer surgery with ileostomy at our hospital between January 2020 and May 2025. Patients were divided into two groups: the skin-bridge-supported in-situ loop ileostomy group (Skin-Bridge group) and the conventional rod-supported loop ileostomy group (Rod group). In the Skin-Bridge group, the tumor was extracted through the planned stoma site in the right lower quadrant, and the ileostomy was supported by a skin bridge. In the Rod group, the tumor was extracted via a midline abdominal incision, and the ileostomy was supported by a rod placed through the stoma loop in the right lower quadrant. The two groups were compared based on baseline characteristics (age, gender, tumor distance from the anal verge), intraoperative outcomes (operation time), and postoperative complications (e.g., stoma leakage, stoma height, parastomal hernia, scar length). From January 2020 to May 2025, a total of 212 patients who underwent laparoscopic rectal cancer surgery with ileostomy were enrolled. These patients were allocated to either the skin-bridge-supported in-situ loop ileostomy group (Skin-Bridge group, n=118) or the rod-supported loop ileostomy group (Rod group, n=94).In the Skin-Bridge group, where the tumor was extracted through the stoma site in the right lower quadrant and the ileostomy was supported by a skin bridge, no instances of stoma flap necrosis or stoma site infection were observed (0%). In the Rod group, the tumor was extracted via a midline abdominal incision with the ileostomy supported by a rod.No significant differences were found between the two groups in baseline characteristics, including gender, age, body mass index (BMI), surgical approach, tumor T-stage, and distance from the anal verge (all P > 0.05).Comparative analysis of postoperative outcomes revealed several significant differences. The Skin-Bridge group demonstrated a shorter operative time (13.1 ± 2.3 min vs. 18.6 ± 4.9 min, P < 0.05) and lower incidence rates of wound infection (0% vs. 7.9%), peristomal dermatitis (3.4% vs. 13.4%), stoma mucosal edema (17.8% vs. 90.4%), and stoma pressure injury (0% vs. 27.7%) (all P < 0.05). Additionally, the Skin-Bridge group was associated with a lower frequency of stoma leakage (1.1 ± 1.0 times vs. 2.2 ± 1.4 times, P < 0.05), a lower rate of parastomal hernia (1.7% vs. 12.8%, P < 0.05), a more favorable stoma height (2.40 ± 0.5 cm vs. 1.3 ± 0.5 cm, P < 0.05), and a shorter scar length (7.8 ± 0.8 cm vs. 12.6 ± 1.1 cm, P < 0.05). In contrast, no significant intergroup differences were identified in stoma mucosa bleeding (P > 0.05). The modified skin-bridge-supported in-situ loop stoma technique demonstrates potential to reduce stoma-related complications, enhance nursing care, improve cosmetic outcomes with a smaller scar, and eliminate the need for a secondary rod-removal procedure. These findings suggest it is a viable and advantageous alternative to the conventional rod-supported method for diverting loop ileostomy.

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