The Selective Use of a Diverting Stoma in Rectal Surgery

Huisman, Daitlin E.; Ingwersen, Erik W; Reudink, Muriël; Bootsma, Boukje T; Slooter, Gerrit D.; Dekker, Jan Willem T.; Daams, Freek

doi:10.1007/s11605-022-05251-x

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“…However, several studies have reported adverse outcomes concerning diverting stoma creation [ 7 ]; therefore, mastering appropriate ileostomy indications can maximise patient benefits. Nevertheless, no clear international consensus on the indication of DI in low rectal cancer exists [ 8 ], and the optimal time for selecting a DI is controversial [ 9 – 11 ]. This study identified and analysed the factors influencing a clinician’s choice of DI and clarified the benefits of DI in anus-preserving surgery for mid-low rectal cancer.…”

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confidence: 99%

What affects the selection of diverting ileostomy in rectal cancer surgery: a single-center retrospective study

Wang,

Guo,

et al. 2024

BMC Surg

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Background The selection of diverting ileostomy (DI) is controversial. This study aimed to explore the factors affecting the selection of diverting ileostomy (DI) following laparoscopic low anterior resection for rectal cancer. Methods This retrospective, case-control study included patients who underwent laparoscopic-assisted sphincter-saving surgery for mid-low rectal cancer from January 2019 to June 2021. Univariate and multivariate analyses were performed on the patient’s clinicopathological characteristics and pelvic dimensions measured by abdominopelvic electron beam computed tomography. Results A total of 382 patients were included in the analysis, of which 182 patients (47.6%) did not undergo DI, and 200 patients (52.4%) underwent DI. The univariate analysis suggested that male sex (p = 0.003), preoperative radiotherapy (p < 0.001), patients with an anastomosis below the levator ani plane (p < 0.001), the intertuberous distance (p < 0.001), the sacrococcygeal distance (p = 0.025), the mid pelvis anteroposterior diameter (p = 0.009), and the interspinous distance (p < 0.001) were associated with performing DI. Multivariate analysis confirmed that preoperative radiotherapy (p = 0.037, odds ratio [OR] = 2.98, 95% confidence interval [CI] = 1.07–8.30), anastomosis below the levator ani plane (p < 0.001, OR = 7.09, 95% CI = 4.13–12.18), and the interspinous distance (p = 0.047, OR = 0.97, 95% CI = 0.93-1.00) were independently associated with performing DI. Conclusion Pelvic parameters also influence the choice of DI. According to this single-center experience, patients with a shorter interspinous distance, particularly narrow pelvic with an interspinous distance of < 94.8 mm, preoperative radiotherapy, and anastomosis below the levator ani plane, prefer to have a DI and should be adequately prepared by the physician.

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