Dumpling Suture Method Versus Traditional Suture Method of Diverting Loop Ileostomy in Laparoscopic Anterior Rectal Resection With Specimen Extraction Through Stoma Incision: A Randomized, Parallel-Controlled Trial

BACKGROUND: In laparoscopic anterior rectal resection with diverting loop ileostomy, specimen extraction through stoma incision avoids auxiliary incisions and contributes to more minimally invasive postoperative outcome, but enlarges the stoma site. Traditional suture method reduces incision size but creates peristomal incisions, prone to stomal complications. We introduce the "dumpling suture method," using a skin-folding technique to reduce incision size without creating peristomal incisions. OBJECTIVE: This study aimed to assess the efficacy of dumpling suture method in reducing stoma-related complications in patients undergoing specimen extraction through stoma incision surgery. DESIGN: Single-center, randomized, parallel-group controlled study. SETTINGS: This study was conducted at tertiary referral center. PATIENTS: Seventy-two patients scheduled for laparoscopic anterior rectal resection surgery with specimen extraction through stoma incision were enrolled, randomly assigned to dumpling suture method or traditional suture method group. INTERVENTIONS: The experimental group received ileostomy creation using dumpling suture method, whereas the control group underwent traditional suture method. MAIN OUTCOME MEASURES: The primary endpoint was the rate of stoma-related complications. Secondary endpoints included peristomal skin lesions, pain scores, and quality of life scores. RESULTS: The dumpling suture method group had a significantly lower overall stomal complication rate compared to traditional suture method (11.1% vs. 41.7%). Dumpling suture method reduced skin-related complications, including fecal dermatitis (8.3% vs. 33.3%), skin erosion or infection (0% vs. 25%), and mucocutaneous detachment (2.8% vs. 13.9%). The peristomal skin infection scores for peristomal skin lesions were lower in dumpling suture method group, and patients reported less stoma pain and improved quality of life. LIMITATIONS: Limitations include its single-center design and inability to blind participants. CONCLUSIONS: The dumpling suture method technique employs skin-folding suture to reduce enlarged stomal incision, effectively decreasing stoma-related complications. This procedure offers a novel suturing approach for loop ileostomy with enlarged incision, effectively eliminating postoperative incisions and minimizing surgical trauma. See Video Abstract.