Cecostomy vs ileostomy for protection of anastomoses in colorectal surgery

Abstract

Background: The most frequently encountered complication of anastomotic surgery is fistula. In addition to the medical history of the patient, local conditions, the operative moment and surgical technique that were chosen, a series of some other factors can interfere, leading to suture disunity. Aim: The aim of the study was to analyze the existence of a relationship between the use of cecostomy (as a mechanism of temporary diversion) and the frequency of anastomotic fistulas. Materials and methods: We conducted a retrospective study, over a period of 7 years, between 2011-2018 taking into consideration 194 patients who benefited from resections completed with anastomoses in the transverse colon, descending colon, sigmoid and rectum. They were divided into two categories: patients who benefited from cecostomy and patients for whom we did not use this technique. The frequency of fistulas was analyzed for the two main groups and in association with each type of surgery. Results: It was observed the existence of a relationship between the appearance of fistulas and the use of a decompression mechanism such as cecostomy in the sense of a lower number of fistulas for the first situation (2.66%) compared to 11.76% for cases without cecostomy (p=0.034). The duration of hospitalization in the group with cecostomy was shorter than in those without this derivative stoma and the postoperative recovery was good. Conclusions: Cecostomy is a useful protection for the anastomosis line, with the advantage that, when the tube is suppressed, the stoma will spontaneously close.