De-functioning stomas: A prospective controlled trial comparing loop ileostomy with loop transverse colostomy

Abstract

Patients undergoing colorectal surgery who required a defunctioning stoma were randomly allocated to receive either a loop ileostomy (n = 23) or transverse loop colostomy (n = 24). Assessment was made during construction, immediately postoperatively, during the period of outpatient supervision and before and after stoma closure. The ileostomy was associated with significantly less odour than the colostomy (P less than 0.01) and required significantly less appliance changes (P less than 0.05). Furthermore eleven patients (58 per cent) with a colostomy experienced three or more problems with stoma management compared with only three patients (18 per cent) with an ileostomy (P less than 0.05). Wound infection was also significantly more common after closure of the colostomy compared with the ileostomy. Both types of stoma were demonstrated objectively to defunction the distal bowel almost completely. These results indicate that a loop ileostomy is the procedure of first choice when a stoma is needed to defunction the distal colorectum.

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

“…Five studies met the inclusion criteria [11][12][13][14][15] . These studies involved 334 patients: 168 in the loop ileostomy group and 166 in the loop colostomy group.…”

“…Two of the trials 13,14 included only patients who underwent anterior resection and total mesorectal excision for rectal cancer. The other three trials 11,12,15 analyzed patients who underwent surgery on the left-side colon and rectum. One of them 12 included emergency operations.…”

“…Four of the studies included 11,12,14,15 described the stomas construction technique. Three studies 11,13,15 reported that the deaths among their patients were not attributable to either formation or closure of the stoma. One trial 14 described three deaths during the early postoperative period following stoma construction.…”

“…One trial 14 described three deaths during the early postoperative period following stoma construction. One study 15 analyzed the outcome of incisional hernia in the stoma wounds that were observed up to 2.5 years after closure. All of the five trials described the statistical analysis.…”

“…Four randomized controlled trials have compared these two different techniques for defunctioning colorectal anastomosis. Two have favored loop transverse colostomy 12,14 , and two have recommended ileostomy 11,15 . In other non-randomized studies, construction of a loop ileostomy has been the preference, in the absence of any hard evidence favoring loop colostomy 16,17,18 .…”