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Surgery Today

, Volume 49, Issue 2, pp 108–117 | Cite as

Loop transverse colostomy versus loop ileostomy for defunctioning of colorectal anastomosis: a systematic review, updated conventional meta-analysis, and cumulative meta-analysis

  • Paschalis GavriilidisEmail author
  • Daniel Azoulay
  • Panos Taflampas
Review Article
  • 296 Downloads

Abstract

Defunctioning of colorectal anastomosis either with loop transverse colostomy or ileostomy was evaluated using updated and cumulative meta-analyses. Studies were identified by a systematic search of Embase, PubMed, Cochrane Library, and Google Scholar databases and were selected as per the PRISMA checklist. Both randomised control trials (RCTs) and retrospective studies were included. A sensitivity analysis was performed, and a cumulative meta-analysis was performed to monitor evidence over time. Significantly more male patients underwent loop ileostomy than transverse colostomy [odds ratio (OR) = 0.59 (95% confidence interval (CI) 0.39, 0.90), p < 0.001, I2 = 48%]. Significantly more colostomies were complicated by stoma prolapse than by ileostomies [OR = 6.32 (95% CI 2.78, 14.35), p < 0.001, I2 = 0%). Patients with ileostomy demonstrated a significantly higher complication rate of high-output stoma than patients with colostomies [Peto OR = 0.16 (95% CI 0.04, 0.55), p = 0.004, I2 = 0%]. Patients with colostomies demonstrated significantly more complications related to stoma reversal, such as wound infections and incisional hernias, than patients with ileostomies [OR = 3.45 (95% CI 2.00, 5.95), p < 0.001, I2 = 0%; OR = 4.80 (95% CI 1.85, 12.44), p < 0.001, I2 = 0%, respectively]. Overall complications related to stoma formation and closure did not demonstrate significant differences; however, their I2 values were 82% and 76%, respectively, suggesting high heterogeneity, which may have influenced the results. A subgroup analysis of RCTs showed no discrepancies when compared to the whole sample. In the cumulative meta-analysis, the effect size of each study was non-significant for the entire period. The demonstrated significant differences did not translate in favour of ileostomy when the overall complications of stoma formation and reversal were evaluated. Confounding factors and underpowered samples may have influenced the results. Future multicentre RCTs with homogeneous populations and adequate power may demonstrate more conclusive evidence regarding the superiority of one procedure over the other.

Keywords

Loop colostomy Temporary transverse colostomy Loop ileostomy Defunctioning stoma Colorectal anastomosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This report does not describe any study with human participants or animals performed by any of the authors.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of General and Colorectal Surgery, Northern Lincolnshire and Goole, DianaPrincess of Wales HospitalGrimsbyUK
  2. 2.Department of SurgeryHenri Mondor University HospitalCréteilFrance

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