What is a colostomy bridge?

What is a Colostomy Bridge?

A colostomy bridge is a supportive device placed beneath a loop colostomy to prevent retraction of the stoma into the abdomen during the early postoperative period, typically removed around the fifth postoperative day. 1

Types of Colostomy Bridges

There are several types of colostomy bridges used in clinical practice:

1. Rigid Bridges:

   • Traditional plastic or rod-like devices
   • Higher complication rates including leakage (42% vs 11% with flexible bridges)
   • Associated with increased risk of peristomal wounds, inflammation, and infection 2

2. Flexible Bridges:

   • More adaptable to stoma size and shape
   • Lower rates of complications 2
   • Better patient comfort

3. T-shaped Support Devices:

   • Novel approach developed for patients at high risk of stoma withdrawal
   • In a 10-year study with 209 patients, prevented stoma withdrawal in all cases
   • Minimal complications (only 6% reported mild discomfort) 1

4. Skin Bridge Techniques:

   • Uses patient's own tissue by joining two inter-digitating skin flaps from stoma margins
   • Creates an adjustable bridge that accommodates colon loops of various diameters
   • Reported to be complication-free and well-tolerated in a series of twenty cases 3

5. Subcutaneous Absorbable Bridges:

   • Fully resorbable material placed subcutaneously
   • Facilitates maturation of the stoma and immediate postoperative fitting of watertight appliances
   • Reported to have minimal complications in both loop ileostomies and colostomies 4

Purpose and Function

Colostomy bridges serve several important functions:

• Prevent stoma retraction into the abdominal cavity during early healing
• Support the exposed bowel loop in a loop ostomy configuration
• Facilitate maturation of the stoma
• Enable immediate postoperative fitting of ostomy appliances 5, 4

Clinical Considerations

When Bridges Are Used

Bridges are typically used in:

• Loop colostomies (more commonly than end colostomies)
• Patients at increased risk of stoma withdrawal
• Temporary diversion procedures 6, 1

Timing of Removal

• Most bridges are removed approximately 5 days after surgery 1
• This allows sufficient time for the stoma to adhere to the abdominal wall

Complications Associated with Bridges

• Leakage under pouching system: More common with rigid bridges (42%) than flexible bridges (11%) 2
• Peristomal skin complications: Related to moisture and pressure, occurring in about 24% of patients with leakage 2
• Discomfort: Reported in approximately 6% of patients with T-shaped devices 1
• Appliance fitting challenges: Bridges can sometimes interfere with proper ostomy appliance placement 5

Current Practice Trends

There is significant variability in bridge use among colorectal surgeons globally, with no clear consensus on their routine application 2. Some institutions have moved away from using bridges entirely, while others continue to use them selectively based on patient risk factors for stoma retraction.

The trend of substituting temporary loop colostomies with loop ileostomies may be advanced by the development of improved bridge technologies like subcutaneous absorbable bridges 4.

Key Points for Clinicians

• Bridge selection should consider the risk of stoma retraction versus potential complications
• Flexible bridges appear to have fewer complications than rigid bridges
• Newer technologies like T-shaped devices and absorbable bridges show promise with minimal complications
• Proper management of bridges is essential for preventing peristomal skin complications
• Involvement of wound/ostomy nurses in bridge management improves outcomes 2