Abstract
Purpose
Even though minor, stoma-related complications significantly impact quality of life, they are often excluded from clinical analyses that compare short-term postoperative outcomes of loop ileostomy and loop colostomy. This study compares stoma-related complications between loop ileostomy and loop colostomy after rectal resection, including minor complications, and discusses the characteristics of diverting stoma types.
Methods
A retrospective review was conducted in patients who underwent diverting stoma construction after rectal resection. Data on patient background and postoperative short-term outcomes, including stoma-related complications and morbidity after stoma closure, were collected and compared between loop ileostomy and loop colostomy groups. Morbidities of all severity grades were targeted for analysis.
Results
A total of 47 patients (27 loop ileostomy, 20 loop colostomy) underwent diverting stoma construction following rectal resection. Overall stoma-related complications, incidence of skin irritation, high-output stoma, and outlet obstruction were significantly higher in the loop ileostomy group but high-output stoma and outlet obstruction were absent in the loop colostomy group. Regarding morbidity after stoma closure, operation times and surgical site infections were significantly higher in the loop colostomy group while anastomotic leakage after diverting stoma closure occurred (2 cases; 15%) in the loop colostomy group but not the loop ileostomy group.
Conclusion
Because stoma-related complications were significantly higher in the loop ileostomy group, and even these minor complications may impair QOL, early loop ileostomy closure is recommended. For loop colostomy, stoma-related morbidities are lower but post-closure leakage is a calculated risk.
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Acknowledgements
The authors extend their thanks to Dr. Bryan J. Mathis of the University of Tsukuba Hospital International Medical Center for language and logical proofing the paper.
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All authors contributed to the study conception and design. The first draft of the manuscript was written by Koichiro Kumano and Daichi Kitaguchi. Data collection was performed by Koichiro Kumano and Eiki Kinoshita. Yohei Owada, Shoko Moue, Kinji Furuya, Yusuke Ohara, Tsuyoshi Enomoto, and Tatsuya Oda commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This study was approved by the Institutional Review Board of the University of Tsukuba Hospital (registration number: R01-110), and informed consent was obtained from all participants in the form of an opt-out option following the Good Clinical Practice Guidelines of the Ministry of Health and Welfare of Japan.
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Kumano, K., Kitaguchi, D., Owada, Y. et al. A comparative study of stoma-related complications from diverting loop ileostomy or colostomy after colorectal surgery. Langenbecks Arch Surg 408, 139 (2023). https://doi.org/10.1007/s00423-023-02877-6
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DOI: https://doi.org/10.1007/s00423-023-02877-6