Intraluminal bypass devices as an alternative to defunctioning stoma in anterior resection: A systematic review of safety and feasibility.

Abstract

To systematically evaluate the safety and feasibility of intraluminal bypass devices (IBDs) as alternatives to defunctioning stoma for colorectal/coloanal anastomoses after anterior resection. The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Endpoints were feasibility (placement, fixation, maintenance, removal) and safety (device-related events, postoperative morbidity and anastomotic leakage). In total, 10 studies evaluating five types of IBDs were included in this systematic review. Each IBD had a head portion with a proximal fixation component and a tail portion consisting of a transanal endoluminal tubular sheath or tube for faecal diversion but with a distinct design. Device-related events included migration, sheath internalization, partial colonic wall erosions and enterocutaneous fistula. Overall postoperative complications were reported in 0-74% and anastomotic leakage in 0-32% across studies. Stoma avoidance ranged from 66.7% to 100%. IBDs are technically feasible and appear acceptably safe, with potential to reduce reliance on defunctioning stoma; however, evidence remains early and heterogeneous. Further studies are needed, and optimization of fixation and anti-migration strategies should be prioritized.