Temporary loop ileostomy or permanent end colostomy for low rectal cancer: making the right choice

Abstract

Low rectal cancer is treated by surgical removal of part of the colon via abdominoperineal resection (APR), ultra-low Hartmann's (ULH) or low anterior resection (LAR), followed by stoma formation. APR and ULH always result in a permanent end colostomy. LAR usually results in anastomosis with a defunctioning loop ileostomy, which can be reversed to restore mostly normal bowel function, making it the procedure of choice. A stoma can be difficult to manage, getting more so with age or infirmity, and complications are frequent, so a temporary stoma is generally preferable for a patient's wellbeing. However, a loop ileostomy is usually more problematic than a permanent colostomy, with greater chance of high output. Meanwhile, reversal surgery is not guaranteed, carries some risk and often results in reduced bowel function. The colorectal multidisciplinary team (MDT) and, in elective surgery, the patient, must decide which is the most appropriate option. The stoma care nurse (SCN) has a vital role in providing pre-operative assessment, supporting informed decision making and siting the stoma, as well as postoperative follow up and support up to and following stoma reversal.