{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:37:13Z","timestamp":1792291033930,"version":"4.4.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007833","name":"Hamad Medical Corporation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007833","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Stoma outlet obstruction (SOO) is a serious postoperative complication that can lead to significant morbidity, including prolonged hospitalization, increased healthcare costs, and reduced quality of life. This study, the first systematic review and meta-analysis on SOO, aims to identify and analyze key risk factors of SOO, calculate its pooled incidence, and systematically review its diagnostic features, clinical symptoms, imaging modalities, management strategies, prognosis, and associated outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis followed PRISMA 2020 guidelines and included 16 retrospective cohort studies, identified through a comprehensive search of multiple databases, with data on risk factors for SOO. The study analyzed four key variables reported by three or more studies, assessed study quality using the MASTER scale, and synthesized findings using the quality effects model to evaluate heterogeneity and publication bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study included 16 retrospective cohort studies involving 2,228 patients, of whom 362 developed SOO. Increased rectus abdominis muscle thickness was found to significantly increase the risk of SOO (odds ratio [OR] 4.04, 95% confidence interval [CI] 2.36\u20136.93). High output stoma was another associated risk factor (OR 4.16, 95% CI 2.03\u20138.51). The type of ileostomy also played a critical role, with loop ileostomy showing a significantly higher risk of SOO compared to end ileostomy (OR 6.53, 95% CI 2.83\u201315.03). Although age was assessed as a potential risk factor, it did not show a statistically significant association with SOO (OR 1.69, 95% CI 0.44\u20136.54).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis identified significant risk factors for SOO, including increased rectus abdominis muscle thickness, high output stoma, loop ileostomy. We also reported other contributing factors, such as ileal pouch\u2013anal anastomosis, shorter ileal pouch-to-ileostomy distance, oral inferior technique, smaller aperture size, higher BMI, and increased subcutaneous fat thickness. The findings emphasize the importance of tailored surgical techniques, such as stoma maturation using the oral superior technique, ensuring no twist at the mesentery, avoiding stoma limb angulation, creating the stoma slightly more proximally in cases of ileal pouch-anal anastomosis, and optimizing aperture size, along with vigilant postoperative care to reduce SOO incidence and improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-025-03892-5","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T06:25:32Z","timestamp":1761719132000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk factors for stoma outlet obstruction: systematic review and meta-analysis"],"prefix":"10.1007","volume":"410","author":[{"given":"Ali","family":"Toffaha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Badr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmood","family":"Al-Dhaheri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Aleter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejaz","family":"Latif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Kurer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noof Al","family":"Naimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issam","family":"Abu-Issa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tausief","family":"Fatima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amjad","family":"Parvaiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abu","family":"Nada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"issue":"2","key":"3892_CR1","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/s00423-015-1275-1","volume":"400","author":"MH Hanna","year":"2015","unstructured":"Hanna MH, Vinci A, Pigazzi A (2015) Diverting ileostomy in colorectal surgery: when is it necessary? Langenbecks Arch Surg 400(2):145\u2013152","journal-title":"Langenbecks Arch Surg"},{"issue":"1","key":"3892_CR2","doi-asserted-by":"publisher","first-page":"E80","DOI":"10.1055\/s-0044-1779603","volume":"44","author":"FDCGG Santos","year":"2024","unstructured":"Santos FDCGG, Barbosa LER, de Ara\u00fajo Teixeira JPM (2024) Ileostomy: early and late complications. J Coloproctology 44(1):E80\u2013E86","journal-title":"J Coloproctology"},{"issue":"8","key":"3892_CR3","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1016\/j.asjsur.2021.01.002","volume":"44","author":"R Maemoto","year":"2021","unstructured":"Maemoto R (2021) Risk factors and management of stoma-related obstruction after laparoscopic colorectal surgery with diverting ileostomy. Asian J Surg 44(8):1037\u20131042","journal-title":"Asian J Surg"},{"key":"3892_CR4","unstructured":"Common terminology criteria for adverse events (CTCAE) (2017)\u00a0Cancer therapy evaluation program (CTEP). Available from: https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/ctc.htm#ctc_50"},{"issue":"139","key":"3892_CR5","first-page":"602","volume":"62","author":"T Fujii","year":"2015","unstructured":"Fujii T et al (2015) Outlet obstruction of temporary loop diverting ileostomy. Hepatogastroenterology 62(139):602\u2013605","journal-title":"Hepatogastroenterology"},{"issue":"1","key":"3892_CR6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s004649900287","volume":"11","author":"L Oliveira","year":"1997","unstructured":"Oliveira L et al (1997) Laparoscopic creation of stomas. Surg Endosc 11(1):19\u201323","journal-title":"Surg Endosc"},{"issue":"3","key":"3892_CR7","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1007\/s11605-016-3329-2","volume":"21","author":"Y Okita","year":"2017","unstructured":"Okita Y et al (2017) Clinical characteristics of stoma-related obstruction after ileal pouch-anal anastomosis for ulcerative colitis. J Gastrointest Surg 21(3):554\u2013559","journal-title":"J Gastrointest Surg"},{"key":"3892_CR8","unstructured":"(2016) The ASCRS Textbook of Colon and Rectal Surgery\u00a0TLH, Scott R Steele, Thomas E Read, Theodore J Saclarides, Anthony J Senagore, Charles B Whitlow, Editor. Springer Cham. p. 1292."},{"issue":"5","key":"3892_CR9","doi-asserted-by":"publisher","first-page":"465","DOI":"10.21873\/cdp.10062","volume":"1","author":"H Enomoto","year":"2021","unstructured":"Enomoto H et al (2021) Risk of outlet obstruction associated with defunctioning loop ileostomy in rectal cancer surgery. Cancer Diagn Progn 1(5):465\u2013470","journal-title":"Cancer Diagn Progn"},{"key":"3892_CR10","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-024-02956-1","author":"Y Fujii","year":"2025","unstructured":"Fujii Y (2025) A novel technique for the construction of an end ileostomy to prevent stoma outlet obstruction after rectal resection and total colectomy: a single-center retrospective study. Surg Today. https:\/\/doi.org\/10.1007\/s00595-024-02956-1","journal-title":"Surg Today"},{"issue":"1","key":"3892_CR11","doi-asserted-by":"publisher","first-page":"18","DOI":"10.23922\/jarc.2023-018","volume":"8","author":"K Ihara","year":"2024","unstructured":"Ihara K et al (2024) Risk factors for stoma outlet obstruction after proctocolectomy for ulcerative colitis. J Anus Rectum Colon 8(1):18\u201323","journal-title":"J Anus Rectum Colon"},{"issue":"2","key":"3892_CR12","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1007\/s00595-023-02704-x","volume":"54","author":"Y Imaizumi","year":"2024","unstructured":"Imaizumi Y (2024) High-output stoma is a risk factor for stoma outlet obstruction in defunctioning loop ileostomies after rectal cancer surgery. Surg Today 54(2):106\u2013112","journal-title":"Surg Today"},{"key":"3892_CR13","doi-asserted-by":"crossref","unstructured":"Michonska I et al (2023) Nutritional issues faced by patients with intestinal stoma: a narrative review. J Clin Med 12(2)","DOI":"10.3390\/jcm12020510"},{"issue":"1","key":"3892_CR14","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-020-00734-7","volume":"20","author":"Y Hara","year":"2020","unstructured":"Hara Y (2020) Organ\/space infection is a common cause of high output stoma and outlet obstruction in diverting ileostomy. BMC Surg 20(1):83","journal-title":"BMC Surg"},{"issue":"1","key":"3892_CR15","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-023-02877-6","volume":"408","author":"K Kumano","year":"2023","unstructured":"Kumano K (2023) A comparative study of stoma-related complications from diverting loop ileostomy or colostomy after colorectal surgery. Langenbecks Arch Surg 408(1):139","journal-title":"Langenbecks Arch Surg"},{"issue":"5","key":"3892_CR16","first-page":"1945","volume":"27","author":"P Caprino","year":"2023","unstructured":"Caprino P (2023) Risk factors and outcomes of restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Retrospective study of 75 single center cases. Eur Rev Med Pharmacol Sci 27(5):1945\u20131953","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"3","key":"3892_CR17","doi-asserted-by":"publisher","first-page":"254","DOI":"10.23922\/jarc.2021-007","volume":"5","author":"T Abe","year":"2021","unstructured":"Abe T et al (2021) Risk factors for outlet obstruction in patients with diverting ileostomy following rectal surgery. J Anus Rectum Colon 5(3):254\u2013260","journal-title":"J Anus Rectum Colon"},{"issue":"3","key":"3892_CR18","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1007\/s00595-020-02096-2","volume":"51","author":"S Sasaki","year":"2021","unstructured":"Sasaki S et al (2021) Risk factors for outlet obstruction after laparoscopic surgery and diverting ileostomy for rectal cancer. Surg Today 51(3):366\u2013373","journal-title":"Surg Today"},{"issue":"2","key":"3892_CR19","first-page":"207","volume":"5","author":"K Kuwahara","year":"2022","unstructured":"Kuwahara K et al (2022) Risk factors for stoma outlet obstruction: preventing this complication after construction of diverting ileostomy during laparoscopic colorectal surgery. JMA J 5(2):207\u2013215","journal-title":"JMA J"},{"issue":"1","key":"3892_CR20","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-024-02926-2","volume":"28","author":"Y Matsumoto","year":"2024","unstructured":"Matsumoto Y (2024) Complications associated with loop ileostomy: analysis of risk factors. Tech Coloproctol 28(1):60","journal-title":"Tech Coloproctol"},{"issue":"2","key":"3892_CR21","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1002\/ags3.12512","volume":"6","author":"R Mori","year":"2022","unstructured":"Mori R et al (2022) Long distance between the superior mesenteric artery root and bottom of the external anal sphincter is a risk factor for stoma outlet obstruction after total proctocolectomy and Ileal-pouch anal anastomosis for ulcerative colitis. Ann Gastroenterol Surg 6(2):249\u2013255","journal-title":"Ann Gastroenterol Surg"},{"issue":"6","key":"3892_CR22","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1007\/s00384-019-03308-z","volume":"34","author":"K Tamura","year":"2019","unstructured":"Tamura K et al (2019) Defunctioning loop ileostomy for rectal anastomoses: predictors of stoma outlet obstruction. Int J Colorectal Dis 34(6):1141\u20131145","journal-title":"Int J Colorectal Dis"},{"issue":"12","key":"3892_CR23","doi-asserted-by":"publisher","first-page":"507","DOI":"10.4240\/wjgs.v12.i12.507","volume":"12","author":"T Kitahara","year":"2020","unstructured":"Kitahara T (2020) Risk factors for postoperative stoma outlet obstruction in ulcerative colitis. World J Gastrointest Surg 12(12):507\u2013519","journal-title":"World J Gastrointest Surg"},{"issue":"12","key":"3892_CR24","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1007\/s00595-018-1698-8","volume":"48","author":"S Okada","year":"2018","unstructured":"Okada S et al (2018) Elevated risk of stoma outlet obstruction following colorectal surgery in patients undergoing ileal pouch-anal anastomosis: a retrospective cohort study. Surg Today 48(12):1060\u20131067","journal-title":"Surg Today"},{"issue":"1","key":"3892_CR25","doi-asserted-by":"publisher","first-page":"25","DOI":"10.23922\/jarc.2017-034","volume":"2","author":"G Ohira","year":"2018","unstructured":"Ohira G (2018) Incidence and risk factor of outlet obstruction after construction of ileostomy. J Anus Rectum Colon 2(1):25\u201330","journal-title":"J Anus Rectum Colon"},{"issue":"7","key":"3892_CR26","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1097\/MEG.0000000000000618","volume":"28","author":"G Dafnis","year":"2016","unstructured":"Dafnis G (2016) Early and late surgical outcomes of ileal pouch-anal anastomosis within a defined population in Sweden. Eur J Gastroenterol Hepatol 28(7):842\u2013849","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"2","key":"3892_CR27","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.jss.2011.03.004","volume":"170","author":"S Dolejs","year":"2011","unstructured":"Dolejs S, Kennedy G, Heise CP (2011) Small bowel obstruction following restorative proctocolectomy: affected by a laparoscopic approach? J Surg Res 170(2):202\u2013208","journal-title":"J Surg Res"},{"issue":"1","key":"3892_CR28","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1097\/00000658-198901000-00007","volume":"209","author":"Y Francois","year":"1989","unstructured":"Francois Y (1989) Small intestinal obstruction complicating ileal pouch-anal anastomosis. Ann Surg 209(1):46\u201350","journal-title":"Ann Surg"},{"issue":"2","key":"3892_CR29","doi-asserted-by":"publisher","first-page":"94","DOI":"10.3393\/ac.2017.06.14","volume":"34","author":"H Kameyama","year":"2018","unstructured":"Kameyama H et al (2018) Small bowel obstruction after ileal pouch-anal anastomosis with a loop ileostomy in patients with ulcerative colitis. Ann Coloproctol 34(2):94\u2013100","journal-title":"Ann Coloproctol"},{"issue":"2","key":"3892_CR30","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1097\/00000658-200202000-00007","volume":"235","author":"AR MacLean","year":"2002","unstructured":"MacLean AR (2002) Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg 235(2):200\u2013206","journal-title":"Ann Surg"},{"issue":"12","key":"3892_CR31","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1007\/BF02052257","volume":"36","author":"PW Marcello","year":"1993","unstructured":"Marcello PW (1993) Obstruction after ileal pouch-anal anastomosis: a preventable complication? Dis Colon Rectum 36(12):1105\u20131111","journal-title":"Dis Colon Rectum"},{"issue":"2","key":"3892_CR32","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1002\/ags3.12017","volume":"1","author":"T Mizushima","year":"2017","unstructured":"Mizushima T et al (2017) Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis. Ann Gastroenterol Surg 1(2):122\u2013128","journal-title":"Ann Gastroenterol Surg"},{"issue":"4","key":"3892_CR33","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1007\/s00595-021-02381-8","volume":"52","author":"Y Takehara","year":"2022","unstructured":"Takehara Y (2022) A technique for constructing diverting loop ileostomy to prevent outlet obstruction after rectal resection and total colectomy: a retrospective single-center study. Surg Today 52(4):587\u2013594","journal-title":"Surg Today"}],"container-title":["Langenbeck's Archives of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-025-03892-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-025-03892-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-025-03892-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T06:25:38Z","timestamp":1761719138000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00423-025-03892-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,29]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3892"],"URL":"https:\/\/doi.org\/10.1007\/s00423-025-03892-5","relation":{},"ISSN":["1435-2451"],"issn-type":[{"value":"1435-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,29]]},"assertion":[{"value":"22 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"317"}}