Advertisement

World Journal of Surgery

, Volume 31, Issue 5, pp 1143–1152 | Cite as

Comparison of Outcomes Following Ileostomy versus Colostomy for Defunctioning Colorectal Anastomoses

  • Henry S. Tilney
  • Parvinder S. Sains
  • Richard E. Lovegrove
  • George E. Reese
  • Alexander G. Heriot
  • Paris P. TekkisEmail author
Article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Incisional Hernia Weighted Mean Difference Loop Ileostomy Colorectal Anastomosis Anastomotic Leakage Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

Acknowledgements

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.

References

  1. 1.
    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;85:1114–1117CrossRefPubMedGoogle Scholar
  2. 2.
    Rullier E, Laurent C, Garrelon JL, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85:355–358CrossRefPubMedGoogle Scholar
  3. 3.
    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;85:526–529CrossRefPubMedGoogle Scholar
  4. 4.
    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;78:196–198CrossRefPubMedGoogle Scholar
  5. 5.
    Pakkastie TE, Luukkonen PE, Jarvinen HJ. Anastomotic leakage after anterior resection of the rectum. Eur J Surg 1994;160:293–297PubMedGoogle Scholar
  6. 6.
    Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005;92:211–216CrossRefPubMedGoogle Scholar
  7. 7.
    Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003;46:653–660CrossRefPubMedGoogle Scholar
  8. 8.
    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;48:2076–2079CrossRefPubMedGoogle Scholar
  9. 9.
    Gooszen AW, Geelkerken RH, Hermans J, et al. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 2000;43:650–655CrossRefPubMedGoogle Scholar
  10. 10.
    Lertsithichai P, Rattanapichart P. Temporary ileostomy versus temporary colostomy: a meta-analysis of complications. Asian J Surg 2004;27:202–210; discussion 211-202PubMedCrossRefGoogle Scholar
  11. 11.
    Clarke M, Horton R. Bringing it all together: Lancet-Cochrane collaborate on systematic reviews. Lancet 2001;357:1728CrossRefPubMedGoogle Scholar
  12. 12.
    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;283:2008–2012CrossRefPubMedGoogle Scholar
  13. 13.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–188CrossRefPubMedGoogle Scholar
  14. 14.
    Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–634PubMedGoogle Scholar
  15. 15.
    Haldane JB. The estimation and significance of the logarithm of a ratio of frequencies. Ann Hum Genet 1956;20:309–311CrossRefPubMedGoogle Scholar
  16. 16.
    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;27:335–371CrossRefPubMedGoogle Scholar
  17. 17.
    Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–748PubMedGoogle Scholar
  18. 18.
    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;77:745–753CrossRefPubMedGoogle Scholar
  19. 19.
    Egger M, Smith GD. Misleading meta-analysis. BMJ 1995;311:753–754PubMedGoogle Scholar
  20. 20.
    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;73:566–570CrossRefPubMedGoogle Scholar
  21. 21.
    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;85:76–79CrossRefPubMedGoogle Scholar
  22. 22.
    Chen F, Stuart M. The morbidity of defunctioning stomata. Aust N Z J Surg 1996;66:218–221CrossRefPubMedGoogle Scholar
  23. 23.
    Sakai Y, Nelson H, Larson D, et al. Temporary transverse colostomy vs loop ileostomy in diversion: a case-matched study. Arch Surg 2001;136:338–342CrossRefPubMedGoogle Scholar
  24. 24.
    Fasth S, Hulten L, Palselius I. Loop ileostomy—an attractive alternative to a temporary transverse colostomy. Acta Chir Scand 1980;146:203–207PubMedGoogle Scholar
  25. 25.
    Nordstrom G, Hulten L. Loop ileostomy as an alternative to transverse loop colostomy. J Enterostomal Ther 1983;10:92–94PubMedGoogle Scholar
  26. 26.
    Rutegard J, Dahlgren S. Transverse colostomy or loop ileostomy as diverting stoma in colorectal surgery. Acta Chir Scand 1987;153:229–232PubMedGoogle Scholar
  27. 27.
    Khoury GA, Lewis MC, Meleagros L, et al. Colostomy or ileostomy after colorectal anastomosis?: a randomised trial. Ann R Coll Surg Engl 1987;69:5–7PubMedGoogle Scholar
  28. 28.
    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;25:274–277CrossRefPubMedGoogle Scholar
  29. 29.
    Tocchi A, Mazzoni G, Miccini M, et al. Use of ileostomy and colostomy as temporal derivation in colorectal surgery. G Chir 2002;23:48–52PubMedGoogle Scholar
  30. 30.
    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;89:704–708CrossRefPubMedGoogle Scholar
  31. 31.
    Gastinger I, Marusch F, Steinert R, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 2005;92:1137–1142CrossRefPubMedGoogle Scholar
  32. 32.
    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;88:360–363CrossRefPubMedGoogle Scholar
  33. 33.
    Ricketts RR, Pettitt BJ. Management of Hirschsprung’s disease in adolescents. Am Surg 1989;55:219–225PubMedGoogle Scholar
  34. 34.
    Branagan G, Finnis D. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 2005;48:1021–1026CrossRefPubMedGoogle Scholar
  35. 35.
    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;240:255–259CrossRefPubMedGoogle Scholar
  36. 36.
    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;46:1200–1207CrossRefPubMedGoogle Scholar
  37. 37.
    Nugent KP, Daniels P, Stewart B, et al. Quality of life in stoma patients. Dis Colon Rectum 1999;42:1569–1574CrossRefPubMedGoogle Scholar
  38. 38.
    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;90:581–582CrossRefPubMedGoogle Scholar
  39. 39.
    Patrascu T, Doran H, Musat O. Protective transanal tube in colo-rectal anastomosis. Chirurgia (Bucur) 2004;99:75–78Google Scholar
  40. 40.
    Tschmelitsch J, Wykypiel H, Prommegger R, et al. Colostomy vs tube cecostomy for protection of a low anastomosis in rectal cancer. Arch Surg 1999;134:1385–1388CrossRefPubMedGoogle Scholar
  41. 41.
    Thomson WH, White S, O’Leary DP. Tube caecostomy to protect rectal anastomoses. Br J Surg 1998;85:1533–1534CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Henry S. Tilney
    • 1
  • Parvinder S. Sains
    • 1
  • Richard E. Lovegrove
    • 1
  • George E. Reese
    • 1
  • Alexander G. Heriot
    • 1
  • Paris P. Tekkis
    • 1
    • 2
    Email author
  1. 1.Department of Biosurgery and Surgical TechnologyImperial College LondonLondonUK
  2. 2.Department of Biosurgery and Surgical TechnologySt. Mary’s HospitalLondonUK

Personalised recommendations