Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

Abstract

Purpose:The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. Methods: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. Results: Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I 2 = 0% for the heterogeneity test. Conclusions: The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials. Key words: Ileostomy. Colostomy. Colorectal surgery. Systematic review. Meta-analysis. RESUMO Objetivo:A controvérsia entre ileostomia em alça ou colostomia em alça como a melhor forma para a descompressão temporária da anastomose colorretal motivou a realização desta revisão. Métodos: Cinco ensaios clínicos casualizados foram incluídos com 334 pacientes: 168 no grupo de ileostomia e 166 no grupo de colostomia. Os resultados analisaram: 1. Mortalidade; 2. Infecção da ferida; 3. Tempo de formação do estoma; 4. Tempo de fechamento do estoma; 5. Intervalo de tempo entre a formação e o fechamento do estoma; 6. Prolapso do estoma; 7. Retração do estoma; 8. Hérnia parastomal; 9. Fistula parastomal; 10. Estenose; 11. Necrose; 12. Irritação de pele; 13. Íleo; 14. Fístula entérica; 15. Reoperação; 16. Adaptação do paciente; 17. Tempo de internação hospitalar; 18. Deiscência da anastomose colorretal; 19. Hérnia de Incisional; 20. Obstrução intestinal pós-operatória. Resultados: Prolapso do estoma: p = 0.00001, mas com heterogeneidade estatística; a análise de sensibilidade foi aplicada excluindo os estudos que incluíram cirurgias de emergência: p = 0.02 e teste de heterogeneidade: I 2 =0%. Conclusões: Os resultados encontrados não foram estatística ou clinicamente significantes, exceto prolapso do estoma. A melhor evidência para a escolha entre ileostomia em alça ou colostomia em alça necessita de maior número de ensaios clínicos.

A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer

“…Endoluminal pressure at the anastomotic site has been reported to be associated with anastomotic leakage [31] and can be an important factor in the prevention of anastomotic leakage after rectal surgery. The proximal diversion, by means of either a colostomy or an ileostomy, minimizes the consequences of anastomotic leakage by preventing fecal flow through the anastomosis [32][33][34].…”

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

“…There is no conclusive study in the literature about the superiority of colostomy or protective ileostomy after transit reconstruction surgery …”

Surgical practice - is it evidence-based?

“…It has been found that the use of a stapler is not superior to the handsewn technique. Moreover the ileostomy technique looks to be the best choice for colorectal anastomoses decompression 4,5,6 . Further research on these surgical issues must be undertaken in order to obtain answers that are more definitive.…”

“…As a result a lot of good scientific evidence has been accumulated, particularly in colorectal surgery. Research questions such as the need for preoperative mechanical bowel preparation, pain control by means of epidural analgesia, time interval until starting postoperative administration of oral fluids and food, choice of surgical technique in colorectal anastomoses, use of drains and use of a nasogastric tube after elective laparotomy have been adressed 1,2,3,4,5,6,7 . Most of these studies are Cochrane reviews focusing on important healthcare interventions with particular emphasis given to surgical practice.…”