Loop transverse colostomy versus loop ileostomy after low and ultralow anterior resection

Abstract

Background: Since the introduction of sphincter saving procedures for low and mid-rectal carcinoma and the associated high anastomotic leakage rate is a matter of troublesome. There is a consensus between surgeons that diverting proximal stoma decreases the incidence of clinical leakage. But the choice between loop transverse colostomy (LTC) and loop ileostomy (LI) still a matter of debate. In this study we tried to compare both methods and evaluate the outcome of each.Methods: This is a prospective observational study included 28 patients suffering from mid- or low-rectal cancer who underwent elective low anterior resection (LARs), admitted to Sohag University Hospital between July 2013 to July 2017. Patients were randomly allocated into two groups; group (A) included 15 patients and managed with LTC, and group (B) included 13 patients and managed with LI. The data of the patients were collected, tabulated and analyzed, with special consideration of the general outcome measures related to stoma construction, special outcome measures related to stoma construction, and the outcome measures related to stoma closure. All of the patients were followed up for 6 months.Results: Author found a significantly higher incidence rate of skin excoriation (p<0.001), leaks from the appliance (p<0.005), in the LI group than in the LTC group and higher incidence of parastomal hernia (p=0.042) in the LTC than in the LI. Also, author found a significantly higher incidence rate of intestinal obstruction in the LI group (p<0.001), also we found a significantly higher incidence of wound infection after stoma closure (p=0.006) in the LTC group than in the LI group. The mean time to first bowel movement (days) was earlier in the LI than LTC group and showing also a significant value (p<0.001). The mean cumulative total hospital stay was significantly longer in the LTC group than in the LI group (p<0.001).Conclusions: LTC and LI; both have advantages and disadvantages and the use of any for fecal diversion after low and mid-rectal carcinoma should be considered for every patient individually according to his circumstances.