Loop ileostomy versus loop transverse colostomy for temporary fecal diversion after colorectal anastomosis

Abstract

Background: Leakage from low colorectal anastomosis could be reduced by using covering stoma to divert fecal stream. Controversy is still present as to whether loop ileostomy (LI) or loop transverse colostomy (LTC) is the optimal method of defunctioning such anastomosis. Methods: Patients requiring defunctioning following anterior resection or emergency left colonic resection were randomized to receive either LI or LTC. Comparison was made between both groups regarding efficacy & complications. The minimum follow up after stoma closure was 3 months (mean 10 months). Results: Between January 2007 and April 2009, 62 patients were randomized into 2 groups (LI 32, LTC 30). There were no significant differences in the mortality, postoperative leakage, stoma prolapse, parastomal hernia, parastomal fistula, incisional hernia, postoperative bowel obstruction, or skin irritation. However, there were significant difference in favour of LI including less evidence of wound infection, less hospital stay, less stomal retraction or necrosis, less time for creation of stoma, less time of bowel transiet and better patient adaptation, while dehydration and time of closure was in favour of LTC. Conclusion: In this randomized study, both methods appear to provide satisfactory protection method for the low colorectal anastomosis, but LI in general was associated with little complications specially wound infection & stoma related complications, which favours it as a covering stoma.