Protective loop ileostomy or colostomy? a risk evaluation of all common complications

Abstract

Protective ileostomy and colostomy are performed in patients undergoing low anterior resection with a high leakage risk. We aimed to compare surgical, medical, and daily care complications between these 2 ostomies in order to make individual choice. Methods: Patients who underwent low anterior resection for rectal tumors with protective stomas between January 2011 and September 2018 were enrolled. Stoma-related complications were prospectively recorded by wound, ostomy, and continence nurses. The cancer stage and treatment data were obtained from the Taiwan Cancer Database of our Big Data Center. Other demographic data were collected retrospectively from medical notes. The complications after stoma creation and after the stoma reversal were compared. Results: There were 176 patients with protective colostomy and 234 with protective ileostomy. Protective ileostomy had higher proportions of high output from the stoma for 2 consecutive days than protective colostomy (11.1% vs. 0%, P < 0.001). Protective colostomy resulted in more stoma retraction than protective ileostomy (21.6% vs. 9.4%, P = 0.001).Female sex, open operation, ileostomy, and carrying stoma more than 4 months were also significantly associated with a higher risk of stoma-related complications during diversion. The incidence of complication after stoma reversal did not differ between colostomy group and ileostomy group (24.3% vs. 20.9%, P = 0.542). Conclusion: We suggest avoiding colostomy in patients who are female and potential prolong diversion when stoma retraction is a concern. Otherwise, ileostomy should be avoided for patients with impaired renal function. Wise selection and flexibility are more important than using one type of stoma routinely.

Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer

“…After removing 1467 duplicate entries, 1900 articles were eliminated based on evaluation of the title and abstract of each article. Subsequently, the remaining 32 papers underwent full-text examination, resulting in the identification of 10 articles that the inclusion criteria for analysis [ 15 , 16 , 18 – 25 ] (Fig. 1 ).…”

“…Eight studies [ 15 , 16 , 18 – 21 , 23 , 24 ] evaluated mortality between the preventive LI and LC groups, while two researchers assessed morbidity [ 20 , 24 ]. There was no significant difference observed in morbidity (RR: 0.95; 95%CI: 0.61–1.46; P = 0.81, Fig.…”

“…Nine studies [ 15 , 16 , 18 – 21 , 23 – 25 ] identified stoma-related problems and demonstrated no statistically significant difference between the two groups (RR: 1.07; 95%CI: 0.82–1.41; P = 0.62). Significant heterogeneity was observed (P < 0.01; I 2 = 67%) (Fig.…”

“…Seven studies [ 15 , 16 , 18 – 21 , 23 ], concluded that LI reduces the incidence of stoma prolapse (RR: 0.39; 95%CI: 0.19–0.82; P = 0.01). The incidence of stoma prolapse was significantly lower in the LI group (1.5%, 9/612) than in the LC group (4.0%, 25/623).…”

“…Seven studies [ 15 , 16 , 18 – 21 , 25 ] reported data of stoma retraction and a comprehensive analysis revealed that stoma stricture was significantly lower in the LI group (4.0%,25/628)compared to the LC group (7.3%,46/627), with no observed heterogeneity (RR: 0.45; 95%CI: 0.29–0.71; P < 0.01; heterogeneity: P = 0.64, I 2 = 0%)(Fig. 4 B).…”