The present study evaluated outcomes of patients undergoing proximal diversion using either a loop ileostomy or loop colostomy following distal colorectal resection for malignant and non-malignant disease.
A literature search of the Medline, Ovid, Embase and Cochrane databases was performed to identify studies published between 1966 and 2006, comparing loop ileostomy and loop colostomy to protect a distal colorectal anastomosis. A random effect meta-analytical technique was used and sensitivity analysis performed on studies published since 2000, higher quality papers, those reporting on 70 or more patients, and those reporting outcomes following colorectal cancer resections.
Seven studies, including three randomised controlled trials, satisfied the inclusion criteria. Outcomes of a total of 1,204 patients were analysed, of whom 719 (59.7%) underwent defunctioning loop ileostomy. High stoma output was more common following ileostomy formation (OR = 5.39, 95% CI: 1.11, 26.12, P = 0.04), but wound infections following their reversal were significantly fewer (OR = 0.21, 95% CI: 0.07, 0.62, P = 0.004). Overall complications were less frequent for ileostomy patients in the subgroup of high quality studies (OR = 0.22, 95% CI: 0.08, 0.59, P = 0.003).
The results of this meta-analysis suggest that ileostomy may be preferable to colostomy when used to defunction a distal colorectal anastomosis. Wound infections following stoma reversal were reduced, as were overall stoma-related complications and incisional hernia following stoma reversal for ileostomy patients in high quality studies.
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Dehni N, Schlegel RD, Cunningham C, et al. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg 1998;85:1114–1117
Rullier E, Laurent C, Garrelon JL, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85:355–358
Carlsen E, Schlichting E, Guldvog I, et al. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 1998;85:526–529
Karanjia ND, Corder AP, Holdsworth PJ, et al. Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg 1991;78:196–198
Pakkastie TE, Luukkonen PE, Jarvinen HJ. Anastomotic leakage after anterior resection of the rectum. Eur J Surg 1994;160:293–297
Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005;92:211–216
Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003;46:653–660
Wong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 2005;48:2076–2079
Gooszen AW, Geelkerken RH, Hermans J, et al. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 2000;43:650–655
Lertsithichai P, Rattanapichart P. Temporary ileostomy versus temporary colostomy: a meta-analysis of complications. Asian J Surg 2004;27:202–210; discussion 211-202
Clarke M, Horton R. Bringing it all together: Lancet-Cochrane collaborate on systematic reviews. Lancet 2001;357:1728
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008–2012
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–188
Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–634
Haldane JB. The estimation and significance of the logarithm of a ratio of frequencies. Ann Hum Genet 1956;20:309–311
Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985;27:335–371
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–748
Athanasiou T, Al-Ruzzeh S, Kumar P, et al. Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients. Ann Thorac Surg 2004;77:745–753
Egger M, Smith GD. Misleading meta-analysis. BMJ 1995;311:753–754
Williams NS, Nasmyth DG, Jones D, et al. De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg 1986;73:566–570
Gooszen AW, Geelkerken RH, Hermans J, et al. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 1998;85:76–79
Chen F, Stuart M. The morbidity of defunctioning stomata. Aust N Z J Surg 1996;66:218–221
Sakai Y, Nelson H, Larson D, et al. Temporary transverse colostomy vs loop ileostomy in diversion: a case-matched study. Arch Surg 2001;136:338–342
Fasth S, Hulten L, Palselius I. Loop ileostomy—an attractive alternative to a temporary transverse colostomy. Acta Chir Scand 1980;146:203–207
Nordstrom G, Hulten L. Loop ileostomy as an alternative to transverse loop colostomy. J Enterostomal Ther 1983;10:92–94
Rutegard J, Dahlgren S. Transverse colostomy or loop ileostomy as diverting stoma in colorectal surgery. Acta Chir Scand 1987;153:229–232
Khoury GA, Lewis MC, Meleagros L, et al. Colostomy or ileostomy after colorectal anastomosis?: a randomised trial. Ann R Coll Surg Engl 1987;69:5–7
Rullier E, Le Toux N, Laurent C, et al. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 2001;25:274–277
Tocchi A, Mazzoni G, Miccini M, et al. Use of ileostomy and colostomy as temporal derivation in colorectal surgery. G Chir 2002;23:48–52
Law WL, Chu KW, Choi HK. Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision. Br J Surg 2002;89:704–708
Gastinger I, Marusch F, Steinert R, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 2005;92:1137–1142
Edwards DP, Leppington-Clarke A, Sexton R, et al. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg 2001;88:360–363
Ricketts RR, Pettitt BJ. Management of Hirschsprung’s disease in adolescents. Am Surg 1989;55:219–225
Branagan G, Finnis D. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 2005;48:1021–1026
Walker KG, Bell SW, Rickard MJ, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 2004;240:255–259
Tang CL, Seow-Choen F, Fook-Chong S, et al. Bioresorbable adhesion barrier facilitates early closure of the defunctioning ileostomy after rectal excision: a prospective, randomized trial. Dis Colon Rectum 2003;46:1200–1207
Nugent KP, Daniels P, Stewart B, et al. Quality of life in stoma patients. Dis Colon Rectum 1999;42:1569–1574
Amin AI, Ramalingam T, Sexton R, et al. Comparison of transanal stent with defunctioning stoma in low anterior resection for rectal cancer. Br J Surg 2003;90:581–582
Patrascu T, Doran H, Musat O. Protective transanal tube in colo-rectal anastomosis. Chirurgia (Bucur) 2004;99:75–78
Tschmelitsch J, Wykypiel H, Prommegger R, et al. Colostomy vs tube cecostomy for protection of a low anastomosis in rectal cancer. Arch Surg 1999;134:1385–1388
Thomson WH, White S, O’Leary DP. Tube caecostomy to protect rectal anastomoses. Br J Surg 1998;85:1533–1534
The authors wish to gratefully acknowledge the help and advice of Mr Thanos Athanasiou, Clinical Senior Lecturer at Imperial College London, in developing the statistical methods and quality scoring utilised in the analysis of data for this paper.
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Tilney, H.S., Sains, P.S., Lovegrove, R.E. et al. Comparison of Outcomes Following Ileostomy versus Colostomy for Defunctioning Colorectal Anastomoses. World J Surg 31, 1143–1152 (2007). https://doi.org/10.1007/s00268-006-0218-y
- Incisional Hernia
- Weighted Mean Difference
- Loop Ileostomy
- Colorectal Anastomosis
- Anastomotic Leakage Rate