Comparison of Stoma Formation Using Circular Stapler Fascial-Aperture Technique (Stapled Trephination) Versus the Traditional Method (Cruciate Fascial Incision): A Retrospective Study at King Faisal Specialist Hospital.

Abstract

<h4>Background and aim</h4>Stoma formation is a critical component of colorectal surgery, with postoperative complications, such as parastomal hernia (PSH), remaining common. The traditional cruciate fascial incision has been the conventional approach, whereas the circular-stapler fascial-aperture technique (stapled trephination) has emerged as an alternative, potentially influencing complication rates. This study aimed to compare two fascial-aperture techniques-traditional cruciate incision and circular-stapler (stapled trephination) and evaluate complication rates and patient-related factors (age, gender, body mass index (BMI), and type of surgery.<h4>Materials and methods</h4>A retrospective hospital-based study was conducted at King Faisal Specialist Hospital, Madinah, Saudi Arabia, from 2021 to 2025. A total of 46 patients undergoing elective gastrointestinal surgeries with stoma formation were included (37 traditional; nine end-to-end anastomosis (EEA)). Patient demographics, types of surgery, and postoperative complications were collected from hospital records. Data were analyzed using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, New York, United States), with chi-square and Fisher's exact tests applied as appropriate.<h4>Results</h4>The study sample consisted of 46 participants with a mean age of 52.1 years. The majority were male (n=34, 73.9%), and 26 patients had a BMI greater than 25 kg/m² (56.5%). The stoma type was mostly traditional (n=37, 80.4%) versus EEA (n=9, 19.6%). Complications were observed in 13 patients (28.3%), with a higher proportion in the EEA (n=3, 33.3%) than in the traditional group (n=10, 27.0%). The most common complication was parastomal hernia (PSH) (17.4%), which occurred more frequently in the traditional group (18.9%) than in the EEA group (11.1%). Less frequent complications included partial necrosis (2.2%) and ischemia (2.2%) in the EEA group, and ileus (2.2%) and abscesses (4.3%) in the traditional group. No significant associations were found between demographic characteristics (age, gender, and BMI) or surgery types and complications (all p > 0.05).<h4>Conclusions</h4>Both traditional and EEA methods of stoma formation demonstrated insignificant complication rates, with each technique exhibiting distinct complication profiles. The most common complication was PSH, which occurred more frequently in the traditional than in the EEA group. Larger, multicenter prospective studies with longer follow-up are needed to determine the long-term safety and efficacy of these methods and to guide surgical decision-making.