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Meta-Analysis
. 2025 May 15;40(1):119.
doi: 10.1007/s00384-025-04862-5.

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

Jian-Xin Gan  1 , Hai-Peng Liu  1 , Kang Chen  2
Affiliations
Meta-Analysis

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

Jian-Xin Gan et al. Int J Colorectal Dis. .

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.

Keywords: Colorectal surgery; Diverting ileostomy; Meta-analysis; Risk factors; Stoma outlet obstruction.

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Conflict of interest statement

Declarations. Institutional review board statement: Not applicable. Consent to participate: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study selection process
Fig. 2
Fig. 2
Forest plot of the prevalence of stoma outlet obstruction after colorectal surgery with diverting ileostomy
Fig. 3
Fig. 3
Sensitivity analysis for the pooled prevalence of stoma outlet obstruction after colorectal surgery with diverting ileostomy
Fig. 4
Fig. 4
Funnel plot for assessing publication bias
Fig. 5
Fig. 5
Funnel plot based on the trim-and-fill method was applied and two “missing” studies were identified
See this image and copyright information in PMC

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