Skip to main content
SpringerLink
Log in

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

Surgery Today Aims and scope Submit manuscript

Cite this article

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Heald RJ. A new approach to rectal cancer. Br J Hosp Med. 1979;22:277–81.

    CAS  PubMed  Google Scholar 

  2. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.

    Article  CAS  Google Scholar 

  3. Aitken RJ. Mesorectal excision for rectal cancer. Br J Surg. 1996;83:214–16.

    Article  CAS  Google Scholar 

  4. Carlsen E, Schlichting E, Guldrog I, Johnson E, Heald RJ. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg. 1998;85:526–29.

    Article  CAS  Google Scholar 

  5. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355–58.

    Article  CAS  Google Scholar 

  6. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg. 2003;90:1261–66.

    Article  CAS  Google Scholar 

  7. Kumar A, Daga R, Vijayaragaran P, Prakash A, Singh RK, Behari E, et al. Anterior resection for rectal carcinoma-risk factors for anastomotic leaks and strictures. World J Gastroenterol. 2011;17:1475–9.

    Article  Google Scholar 

  8. Bax TW, McNevin MS. The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis. Am J Surg. 2007;193:585–7.

    Article  Google Scholar 

  9. Gessler B, Haglid E, Angete E. Loop ileostomies in colorectal cancer patients-morbidity and risk factors for non-reversal. J Surg Res. 2012;178:708–14.

    Article  Google Scholar 

  10. Lertsithichai P, Rattanapichart P. Temporary ileostomy versus temporary colostomy: a meta-analysis of complications. Asian J Surg. 2004;27:202–10.

    Article  Google Scholar 

  11. Güenaga KF, Lustosa SA, Saad SS, Sacomato H, Matos D. Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Act Cir Bras. 2008;23:294–303.

    Article  Google Scholar 

  12. Tilney HS, Sains PS, Loregrove RE, Reese GE, Heriot AG, Tekkis PP. Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg. 2007;31:1142–51.

    Article  Google Scholar 

  13. Higgins JPT, Greens S, editors Cochrane handbook for systematic reviews of interventions version 5.1 [update March 2011]. The Cochrane Collaboration 2011. http://www.cochrane.handbook.org.

  14. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_ epidemiology/oxford.asp.

  15. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  Google Scholar 

  16. Hozo SP, Diulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

    Article  Google Scholar 

  17. Harbord RM, Harris RJ, Sterne JA. Updated tests for small-study effects in meta-analyses. Stata J. 2009;9:197–210.

    Article  Google Scholar 

  18. Williams NS, Nasmyth DG, Jones D, Smith AH. De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg. 1986;73:566–70.

    Article  CAS  Google Scholar 

  19. Khoury GA, Lewis MC, Meleagros L, Lewis AA. Colostomy or ileostomy after colorectal anastomosis? A randomized trial. Ann R Coll Surg Engl. 1987;69:57.

    Google Scholar 

  20. Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg. 1998;85:76–9.

    Article  CAS  Google Scholar 

  21. Sakai Y, Nelson H, Larson D, Maidl L, Young-Fadok T, Ilstrup D. Temporary transverse colostomy vs loop ileostomy in diversion; a case-study. Arch Surg. 2001;136:338–42.

    Article  CAS  Google Scholar 

  22. Edwards DP, Leppington-Clarke A, Sexton R, Heald RJ, Moran BJ. Stoma-related complication are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg. 2001;88:360–63.

    Article  CAS  Google Scholar 

  23. Rullier E, Le Toux N, Laurent C, Garellon JL, Parneix M, Saric J. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg. 2001;25:274–7.

    Article  CAS  Google Scholar 

  24. 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;89:704–8.

    Article  CAS  Google Scholar 

  25. Gastinger I, Marush F, Steinert R, Wolff S, Koeckerling F, Lippert H, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92:1137–42.

    Article  CAS  Google Scholar 

  26. Mala T, Nesbakken A. Morbidity related to the use of a protective stoma I anterior resection for rectal cancer. Colorectal Dis. 2008;10:785–8.

    Article  CAS  Google Scholar 

  27. Klink CD, Lioupis K, Binnebösel M, Kaemmer D, Kozubek I, Grommes J, et al. Diversion stoma after colorectal surgery: loop colostomy or ileostomy. Int J Colorectal Dis. 2011;26:431–36.

    Article  Google Scholar 

  28. Lau J, Antman EM, Jimenez-Silva J, Kupelnick B, Mosteller F, Chalmers TC. Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med. 1992;327:248–54.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Colorectal Surgery, Northern Lincolnshire and Goole, Diana, Princess of Wales Hospital, Scartho Road, Grimsby, DN33 2BA, UK

    Paschalis Gavriilidis & Panos Taflampas

  2. Department of Surgery, Henri Mondor University Hospital, 94010, Créteil, France

    Paschalis Gavriilidis & Daniel Azoulay

Authors
  1. Paschalis Gavriilidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Azoulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Panos Taflampas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paschalis Gavriilidis.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gavriilidis, P., Azoulay, D. & Taflampas, P. Loop transverse colostomy versus loop ileostomy for defunctioning of colorectal anastomosis: a systematic review, updated conventional meta-analysis, and cumulative meta-analysis. Surg Today 49, 108–117 (2019). https://doi.org/10.1007/s00595-018-1708-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-018-1708-x

Keywords

search

Navigation