Prevalence and pooled risk factors of stoma outlet obstruction after colorectal surgery with diverting ileostomy: a systematic review and meta-analysis.

Abstract

Background: Stoma outlet obstruction (SOO) is a significant complication following colorectal surgery with diverting ileostomy, but its prevalence and associated risk factors are not fully understood. This meta-analysis aimed to quantify the prevalence of SOO and identify key risk factors influencing its occurrence.

Methods: A systematic review and meta-analysis of 19 studies comprising 3287 patients were conducted. Pooled prevalence and odds ratios (ORs) for risk factors were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity, and publication bias was assessed using funnel plots and Egger's regression test.

Results: The pooled prevalence of SOO was 14% (95% CI = 11-18%, I² = 84.9%). Subgroup analysis revealed higher prevalence in studies focusing on benign conditions (20%) and smaller sample sizes (< 100 patients, 16%). Key risk factors included high-output syndrome (OR = 4.23, 95% CI = 2.28-7.85), increased rectus abdominis thickness (OR = 3.51, 95% CI = 2.27-5.41), and laparoscopic surgery (OR = 4.04, 95% CI = 1.62-10.04). While publication bias was detected, but the trim-and-fill method indicated that the adjusted prevalence remained basically consistent with the overall pooled estimate.

Conclusions: SOO occurs in approximately 14% of patients undergoing colorectal surgery with diverting ileostomy. Key modifiable factors included high-output syndrome, rectus abdominis thickness, and laparoscopic surgery.