Skip to main content

Advertisement

SpringerLink
Log in

Temporary loop ileostomy versus transverse colostomy for laparoscopic colorectal surgery: a retrospective study

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To compare the surgical outcomes of ileostomy vs. transverse colostomy and investigate which is more suitable for a diverting stoma.

Methods

We assessed stoma-related complications and surgical outcomes, retrospectively, for 146 patients who underwent laparoscopic colorectal surgery with a temporary loop ileostomy or transverse colostomy. Complications after secondary stoma closure surgery were also analyzed.

Results

After the primary surgery, the incidence of prolapse was significantly higher in the transverse colostomy group, whereas high-output stoma and skin irritation were seen more frequently in the ileostomy group. The median interval to stoma closure was shorter in the ileostomy group than in the transverse colostomy group (144 vs. 196 days). After secondary closure surgery, the incidence of wound infection was significantly higher in the transverse colostomy group than in the ileostomy group. None of the patients in the ileostomy group had severe complications. The median postoperative hospital stay was significantly shorter in the ileostomy group than in the transverse colostomy group (10 vs. 13 days).

Conclusions

The findings of this study suggest that ileostomy should be the procedure of choice for short-term temporary diverting stoma, but that transverse colostomy is more appropriate for patients who require a long-term or permanent stoma.

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

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the author, Iku Higashimoto, upon reasonable request.

References

  1. Kim NK, Lim DJ, Yun SH, Sohn SK, Min JS. Ultralow anterior resection and coloanal anastomosis for distal rectal cancer: functional and oncological results. Int J Colorectal Dis. 2001;16:234–7. https://doi.org/10.1007/s003840100306.

    Article  CAS  PubMed  Google Scholar 

  2. Janavikula Sankaran R, Kollapalayam Raman D, Raju P, Syed A, Rajkumar A, Aluru JR, et al. Laparoscopic ultra low anterior resection: single center, 6-year study. J Laparoendosc Adv Surg Tech A. 2020;30:284–91. https://doi.org/10.1089/lap.2019.0652.

    Article  PubMed  Google Scholar 

  3. Gu WL, Wu SW. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies. World J Surg Oncol. 2015;13:9. https://doi.org/10.1186/s12957-014-0417-1.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis. 2010;12:958–64. https://doi.org/10.1111/j.1463-1318.2009.02006.x.

    Article  CAS  PubMed  Google Scholar 

  5. Kabeshima Y, Watanabe M, Hasegawa H, Yamamoto S, Endo T, Yamauchi T, et al. Diverting stomas: comparing loop ileostomy with loop transverse colostomy. Jpn J Gastroenterological Surg. 2001;34:1395–9.

    Article  Google Scholar 

  6. Edwards DP, Chisholm EM, Donaldson DR. Closure of transverse loop colostomy and loop ileostomy. Ann R Coll Surg Engl. 1998;80:33–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. 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. https://doi.org/10.1046/j.1365-2168.1998.00526.x.

    Article  CAS  PubMed  Google Scholar 

  8. Khoury GA, Lewis MC, Meleagros L, Lewis AA. Colostomy or ileostomy after colorectal anastomosis?: a randomised trial. Ann R Coll Surg Engl. 1987;69:5–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. 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. https://doi.org/10.1002/bjs.1800730717.

    Article  CAS  PubMed  Google Scholar 

  10. Sakai Y, Nelson H, Larson D, Maidl L, Young-Fadok T, Ilstrup D. Temporary transverse colostomy vs loop ileostomy in diversion: a case-matched study. Arch Surg. 2001;136:338–42. https://doi.org/10.1001/archsurg.136.3.338.

    Article  CAS  PubMed  Google Scholar 

  11. Caricato M, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R. Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis. 2007;9:559–61. https://doi.org/10.1111/j.1463-1318.2006.01187.x.

    Article  CAS  PubMed  Google Scholar 

  12. Gastinger I, Marusch 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. https://doi.org/10.1002/bjs.5045.

    Article  CAS  PubMed  Google Scholar 

  13. Rullier E, Le Toux N, Laurent C, Garrelon 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. https://doi.org/10.1007/s002680020091. (discussion 7–8).

    Article  CAS  PubMed  Google Scholar 

  14. Lertsithichai P, Rattanapichart P. Temporary ileostomy versus temporary colostomy: a meta-analysis of complications. Asian J Surg. 2004;27:202–10. https://doi.org/10.1016/S1015-9584(09)60033-6. (discussion 11–2).

    Article  PubMed  Google Scholar 

  15. 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. 2019;49:108–17. https://doi.org/10.1007/s00595-018-1708-x.

    Article  PubMed  Google Scholar 

  16. Rondelli F, Reboldi P, Rulli A, Barberini F, Guerrisi A, Izzo L, et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis. 2009;24:479–88. https://doi.org/10.1007/s00384-009-0662-x.

    Article  CAS  PubMed  Google Scholar 

  17. Geng HZ, Nasier D, Liu B, Gao H, Xu YK. Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma. Ann R Coll Surg Engl. 2015;97:494–501.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tilney HS, Sains PS, Lovegrove 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. https://doi.org/10.1007/s00268-006-0218-y.

    Article  PubMed  Google Scholar 

  19. Chudner A, Gachabayov M, Dyatlov A, Lee H, Essani R, Bergamaschi R. The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg. 2019;404:129–39. https://doi.org/10.1007/s00423-019-01758-1.

    Article  CAS  PubMed  Google Scholar 

  20. Brierley JGMKWC. TNM Classification of Malignant Tumours; 2017.

  21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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. https://doi.org/10.1046/j.1365-2168.2002.02082.x.

    Article  CAS  PubMed  Google Scholar 

  23. 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;26:431–6. https://doi.org/10.1007/s00384-010-1123-2.

    Article  PubMed  Google Scholar 

  24. Wu X, Lin G, Qiu H, Xiao Y, Wu B, Zhong M. Loop ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy. Eur J Med Res. 2018;23:24. https://doi.org/10.1186/s40001-018-0325-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Harris DA, Egbeare D, Jones S, Benjamin H, Woodward A, Foster ME. Complications and mortality following stoma formation. Ann R Coll Surg Engl. 2005;87:427–31. https://doi.org/10.1308/003588405X60713.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Koide Y, Maeda K, Katsuno H, Hanai T, Masumori K, Matsuoka H, et al. Outcomes of stapler repair with anastomosis for stoma prolapse. Surg Today. 2021;51:226–31. https://doi.org/10.1007/s00595-020-02076-6.

    Article  PubMed  Google Scholar 

  27. Sun X, Han H, Qiu H, Wu B, Lin G, Niu B, et al. Comparison of safety of loop ileostomy and loop transverse colostomy for low-lying rectal cancer patients undergoing anterior resection: a retrospective, single institute, propensity score-matched study. J BUON. 2019;24:123–9. https://doi.org/10.1046/j.1365-2168.2001.01727.x.

    Article  PubMed  Google Scholar 

  28. Prassas D, Vossos V, Rehders A, Knoefel WT, Krieg A. Loop ileostomy versus loop colostomy as temporary deviation after anterior resection for rectal cancer. Langenbecks Arch Surg. 2020;405:1147–53. https://doi.org/10.1007/s00423-020-01940-w.

    Article  PubMed  Google Scholar 

  29. Edwards DP, Leppington-Clarke A, Sexton R, Heald RJ, Moran BJ. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg. 2001;88:360–3. https://doi.org/10.1046/j.1365-2168.2001.01727.x.

    Article  CAS  PubMed  Google Scholar 

  30. Barrier A, Martel P, Dugue L, Gallot D, Malafosse M. Direct and reservoir colonic-anal anastomoses. Short and long term results. Ann Chir. 2001;126:18–25.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

No additional investigators were involved in this research project. No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka City, Iwate, 020-0066, Japan

    Iku Higashimoto, Jin Teshima, Masahiro Usuda & Go Miyata

  2. Department of Surgery, Tohoku University, 1-1, Seiryo-Cho, Aoba-Ku, Sendai City, Miyagi, 980-8574, Japan

    Iku Higashimoto & Yohei Ozawa

Authors
  1. Iku Higashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin Teshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yohei Ozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masahiro Usuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Go Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Teshima.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare in association with the present study.

Ethical approval

The Ethical Committee of Iwate Prefectural Central Hospital reviewed and approved this study, which was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards (approval number: 537).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Higashimoto, I., Teshima, J., Ozawa, Y. et al. Temporary loop ileostomy versus transverse colostomy for laparoscopic colorectal surgery: a retrospective study. Surg Today 53, 621–627 (2023). https://doi.org/10.1007/s00595-022-02632-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-022-02632-2

Keywords

Search

Navigation