Diversion stoma after colorectal surgery: loop colostomy or ileostomy?

Abstract

Both methods provide a good operative outcome with low complication rates. We do recommend the loop ileostomy in all patients in which dehydration is not to be expected since wound infection rate is lower and hospital stay is shorter during stoma reversal.

Increased postoperative complications after protective ileostomy closure delay: An institutional study

“…Although both ileostomies and colostomies can be safe, the latter present a higher rate of infection after reversal. Therefore many authors recommend protective ileostomies for fecal diversion, if dehydration is not to be expected [15] . The rate of wound infection in our study (12.9%) was similar to other published data [16] .…”

Clinical Practice Guidelines for Ostomy Surgery

“…46 the higher output of ileostomies has been associated with greater rates of dehydration, greater need for dietary alterations, and higher readmission rates in published trials. 38,44,47,48 in summary, available evidence shows that loop ileostomy and transverse loop colostomy both effectively divert the fecal stream and minimize the consequences of anastomotic dehiscence; however, loop ileostomy is associated with less risk of prolapse and decreased infectious complications, and may result in improved patient experience. for these reasons, contemporary colorectal surgical practice typically favors diverting ileostomy.…”

“…Wound infection rates following stoma reversal are significantly higher for diverting colostomies, ranging from 5% to 20% compared with approximately 3% for ileostomies. 33,34,[39][40][41]44,45,47 sepsis may be slightly more common following loop transverse colostomies (oR, 0.54; 95% Ci, 0.30-0.99), 48 as is stomal prolapse, which occurs in up to 42% of patients with transverse loop colostomies. 38,46,48 finally, patients undergoing loop ileostomy may have a better quality of life than patients undergoing colostomy, because of decreased odor, less need to adjust clothing secondary to prolapse, and greater ease of ostomy care.…”

“…[33][34][35][36][37][38][39][40][41][42][43][44] several meta-analyses have also been performed based on this evidence, and results are conflicting, in part, owing to significant heterogeneity among studies. [45][46][47][48] in summary, available evidence shows that loop ileostomy and transverse loop colostomy both effectively divert the fecal stream 48 and minimize the consequences of anastomotic dehiscence.…”

Effect of Diversion Ileostomy on the Occurrence and Consequences of Chemotherapy-Induced Diarrhea

“…[17][18][19] for many institutions, the use of a temporary loop ileostomy is the favored method of fecal diversion, with proponents citing the benefits of decreased stomal prolapse, decreased wound infection rates, and a shorter hospital stay after reversal when compared with a diverting colostomy. [20][21][22] however, the presence of a colostomy has been shown not to impact CiD occurrence during 5-fubased chemotherapy, although the effect of an ileostomy remains unknown. 10 high ileostomy output is a well-recognized problem and is often difficult to manage.…”