Loop ileostomy versus transverse colostomy as a covering stoma after anterior resection for rectal cancer

Abstract

Background: Most colorectal cancer occurs due to lifestyle and increase age with only a minority of cases associated with underlying genetic disorders and environmental factors enables us to move in the direction of a complete assessment of disease risk. The objective of the present study was to compare between two different types of diverting stoma (loop ileostomy and transverse colostomy) as regard immediate and remote complications in patient with rectal cancer treated by restorative resection.Methods: A prospective randomized comparative clinical study was conducted on 50 patients who underwent anterior resection and low anterior resection for rectal cancer divided into two groups: Group I consisted of 25 patients who underwent by loop ileostomy. Group II consisted of 25 patients who underwent by loop transverse colostomy. All patients attended to surgical oncology unit of Sayed Galal hospital, Al Azhar University, Cairo, Egypt during the period from October 2018 to October 2019. Full history, routine, physical examination, routine and imaging investigations were done.Results: 80% and 84% of loop ileostomy and transverse colostomy patients had anterior resection, respectively with no statistically significant differences between the two studied groups regarding anterior resection. Patient who treated by loop ileostomy had deceased time of closure (5.2±0.25 weeks) and stay in hospital (5.16±1.65 and 3.29±0.55 days) than those treated by transverse colostomy (9.6±0.37 weeks) and (7.44±2.58 and 6.03±1.97 days) respectively.Conclusions: Egyptians have unique tumor characters and behavior, and different compliance with treatment regimens. Multicenter prospective studies, as well as evolving Egyptian treatment guidelines are needed to address this.

Revising Our Concepts about Stoma Covering a Low Rectal Anastomosis

“…3,7,12 In our study, we recorded comparable incidences of stomal prolapse, stenosis, necrosis, and parastomal hernia in the two groups, with no statistically significant differences. This is similar to what has been reported by some authors; 3,5,12 however, some auhtors 7,17 recorded a higher incidence of stomal prolapse in the colostomy group when compared with the ileostomy group. Also, there was a higher incidence of stomal retraction in our colostomy group than in the ileostomy group, in contrast with most of the other authors.…”

“…Also, there was a higher incidence of stomal retraction in our colostomy group than in the ileostomy group, in contrast with most of the other authors. 3,5,7,12,17 Regarding peristomal dermatitis, we concluded a definite higher risk of skin irritation in the ileostomy group than in the colostomy group, and this can be explained by the higher output of the ileostomy with high enzymatic contents, which is in line with some studies, 3,6,18 while others found no significant difference between the two procedures; 1,5,7 however, surprisingly, Rullier et al 19 reported a higher incidence of skin irritation in the colostomy group.…”

“…3 We reported a significantly higher incidence of wound infection after closure of colostomy than after ileostomy, but no statistically significant differences regarding other complications of closure of the stoma between the two groups, which is in line with what has been reported by most studies. 3,5,7,16,20 However, others 17,19 showed a lower risk of complications related to closure of ileostomy, and on the other hand, 6,14,15 preferred colostomy as a covering stoma due to its lower morbidity and safer closure. Gastinger et al 6 explained the higher complication rate seen after closure of an ileostomy due to the fact that a segmental resection is usually required, whereas, provided that the posterior wall is intact, colostomy closure can be achieved simply by suturing the defect in the anterior wall.…”

“…1,12,13 Others support routine use of colostomy, claim-ing fewer complications from this procedure, 6,14,15 and others did not prefer one procedure over the other. 3,5,16 In our study, 48 patients with elective low rectal resection and covering stoma were included in 2 groups, each consisting of 24 patients. The first group had patients with covering ileostomy and the second group had patients with covering transverse colostomy.…”

“…[1][2][3] Prophylactic proximal fecal diversion for a low rectal anastomosis is practiced to decrease the incidence of anastomotic leakage and reoperation, which can be achieved by using either a loop transverse colostomy or a loop ileostomy. 2,4,5 There has been conclusive evidence that stoma defunctioning 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.…”