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DOI: 10.1055/s-0041-1730367
Revising Our Concepts about Stoma Covering a Low Rectal Anastomosis
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Abstract
Introduction There has been conclusive evidence that defunctioning stoma with either transverse colostomy or ileostomy mitigates the serious consequences of anastomotic leakage. However, whether transverse colostomy or ileostomy is preferred for defunctioning a rectal anastomosis remains controversial. The present study was designed to identify the best defunctioning stoma for colorectal anastomosis.
Objective To improve the quality of life in patients with rectal resection and anastomosis and reduce the morbidity before and after closure of the stoma.
Patients and Methods The present study included 48 patients with elective colorectal resection who were randomly arranged into 2 equal groups, with 24 patients each. Group I consisted of patients who underwent ileostomy, and group II consisted of patients who underwent colostomy as a defunctioning stoma for a low rectal anastomosis. All surviving patients were readmitted to have their stoma closed and were followed-up for 6 months after closure of their stomas. All data regarding local and general complications of construction and closure of the stoma of the two groups were recorded and blotted against each other to clarify the most safe and tolerable procedure.
Results We found that all nutritional deficiencies, dehydration, electrolytes imbalance, peristomal dermatitis, and frequent change of appliances are statistically more common in the ileostomy group, while stomal retraction and wound infection after closure of the stoma were statistically more common in the colostomy group. There were no statistically significant differences regarding the total hospital stay and mortality between the two groups.
Conclusion and Recommendation Ileostomy has much higher morbidities than colostomy and it also has a potential risk of mortality; therefore, we recommend colostomy as the ideal method for defunctioning a distal colorectal anastomosis.
Publication History
Received: 21 December 2020
Accepted: 22 March 2021
Article published online:
19 July 2021
© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Abudeeb H, Hammad A, Ugwu A. et al. Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: A retrospective analysis of stoma database. Ann Med Surg (Lond) 2017; 21: 114-117
- 2 Trencheva K, Morrissey KP, Wells M. et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 2013; 257 (01) 108-113
- 3 Ali AM. Loop transverse colostomy versus loop ileostomy after low and ultralow anterior resection. International Surgery Journal 2018; 5 (05) 1633-1639
- 4 Belalla D, Kacani N, Gjata A. Evaluation of protective stoma in rectal cancer surgery. Merit Research Journal of Medicine and Medical Sciences 2016; 4 (01) 21-24
- 5 Bendary SH, Abd Elfatah T, Ramadan MK. Loop ileostomy versus transverse colostomy as a covering stoma after anterior resection for rectal cancer. International Surgery Journal 2019; 6 (12) 4216-4222
- 6 Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H. Working Group ‘Colon/Rectum Carcinoma’. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 2005; 92 (09) 1137-1142
- 7 Gavriilidis P, Azoulay D, Taflampas P. Loop transverse colostomy versus loop ileostomy for defunctioning of colorectal anastomosis: a systematic review, updated conventional meta-analysis, and cumulative meta-analysis. Surg Today 2019; 49 (02) 108-117
- 8 Ajani JA. In rectal carcinoma, colostomy or no colostomy: is this the question?. J Clin Oncol 1993; 11 (01) 193-194
- 9 Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998; 85 (03) 355-358
- 10 Bell SW, Walker KG, Rickard MJ. et al. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 2003; 90 (10) 1261-1266
- 11 Kumar A, Daga R, Vijayaragavan P. et al. Anterior resection for rectal carcinoma - risk factors for anastomotic leaks and strictures. World J Gastroenterol 2011; 17 (11) 1475-1479
- 12 Klink CD, Lioupis K, Binnebösel M. et al. Diversion stoma after colorectal surgery: loop colostomy or ileostomy?. Int J Colorectal Dis 2011; 26 (04) 431-436
- 13 Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 2007; 246 (02) 207-214
- 14 Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 1998; 85 (01) 76-79
- 15 Law WL, Chu KW, Choi HK. Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision. Br J Surg 2002; 89 (06) 704-708
- 16 Hocevar B, Gray M. Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury. J Wound Ostomy Continence Nurs 2008; 35 (02) 159-166
- 17 Rondelli F, Reboldi P, Rulli A. et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 2009; 24 (05) 479-488
- 18 Kaidar-Person O, Person B, Wexner SD. Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg 2005; 201 (05) 759-773
- 19 Rullier E, Le Toux N, Laurent C, Garrelon JL, Parneix M, Saric J. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 2001; 25 (03) 274-277 , discussion 277–278
- 20 Sakai Y, Nelson H, Larson D, Maidl L, Young-Fadok T, Ilstrup D. Temporary transverse colostomy vs loop ileostomy in diversion: a case-matched study. Arch Surg 2001; 136 (03) 338-342