Left-Sided Ileostomy at Specimen Extraction Site in Laparoscopic-Assisted Low Anterior Resection for Rectal Cancer

Abstract

Prophylactic ileostomy is usually created at the right lower quadrant (RLQ) because of its vicinity to the ileocecal valve. In the laparoscopic procedure, however, another wound is required for stoma, resulting in a scar after takedown. This study assessed the feasibility of left-sided ileostomy (LI) at the specimen extraction site in laparoscopic-assisted low anterior resection (LAR) for rectal cancer. One hundred five patients underwent laparoscopic LAR with diverting ileostomy for rectal cancer. Among them, 82 (78.1%) received preoperative chemoradiotherapy (CRT). Diverting stomas were created in the RLQ in 49 (46.7%) and in the left lower quadrant in 53 patients (53.3%). We compared surgical morbidity and recovery data between the right-sided ileostomy (RI) and LI groups. The two groups were similar with regard to age, sex, type of CRT, distance from the anal verge, and TNM stage. Parastomal hernia developed in 3 patients (1 in RI, 2 in LI) and postoperative ileus in 10 patients (4 in RI, 6 in LI). The frequency of complications showed no difference between the two groups (10.2% in RI, 14.3% in LI; P=.53). There was also no difference in terms of time to resumption of regular diet (2.9 versus 3.2 days; P=.25) or length of hospital stay (7.9 versus 7.7 days; P=.61). LI in laparoscopic LAR was not associated with increased postoperative morbidity or delay in postoperative recovery. Because it can provide better cosmesis, it would be a possible option for diversion in laparoscopic LAR.