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International Journal of Colorectal Disease

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Open Access 01-12-2024 | Enterostomy | REVIEW

Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer

Authors: Shilai Yang, Gang Tang, Yudi Zhang, Zhengqiang Wei, Donglin Du

Published in: International Journal of Colorectal Disease | Issue 1/2024

Abstract

Purpose

Anastomotic leakage is a serious complication of colorectal cancer surgery, prolonging hospital stays and impacting patient prognosis. Preventive colostomy is required in patients at risk of anastomotic fistulas. However, it remains unclear whether the commonly used loop colostomy(LC) or loop ileostomy(LI) can reduce the complications of colorectal surgery. This study aims to compare perioperative morbidities associated with LC and LI following anterior rectal cancer resection, including LC and LI reversal.

Methods

In this meta-analysis, the Embase, Web of Science, Scopus, PubMed, and Cochrane Library databases were searched for prospective cohort studies, retrospective cohort studies, and randomized controlled trials (RCTs) on perioperative morbidity during stoma development and reversal up to July 2023, The meta-analysis included 10 trials with 2036 individuals (2 RCTs and 8 cohorts).

Results

No significant differences in morbidity, mortality, or stoma-related issues were found between the LI and LC groups after anterior resection surgery. However, patients in the LC group exhibited higher rates of stoma prolapse (RR: 0.39; 95%CI: 0.19–0.82; P = 0.01), retraction (RR: 0.45; 95%CI: 0.29–0.71; P < 0.01), surgical site infection (RR: 0.52; 95%CI: 0.27–1.00; P = 0.05) and incisional hernias (RR: 0.53; 95%CI: 0.32–0.89; P = 0.02) after stoma closure compared to those in the LI group. Conversely, the LI group showed higher rates of dehydration or electrolyte imbalances(RR: 2.98; 95%CI: 1.51–5.89; P < 0.01), high-output(RR: 6.17; 95%CI: 1.24–30.64; P = 0.03), and renal insufficiency post-surgery(RR: 2.51; 95%CI: 1.01–6.27; P = 0.05).

Conclusion

Our study strongly recommends a preventive LI for anterior resection due to rectal cancer. However, ileostomy is more likely to result in dehydration, renal insufficiency, and intestinal obstruction. More multicenter RCTs are needed to corroborate this.

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Title: Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer
Authors: Shilai Yang
Gang Tang
Yudi Zhang
Zhengqiang Wei
Donglin Du
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Enterostomy
Enterostomy
Ileostomy
Colostomy
Rectal Cancer
Rectal Cancer
Incisional Hernia
Colorectal Cancer
Colorectal Cancer
Ileus
Published in: International Journal of Colorectal Disease / Issue 1/2024
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-024-04639-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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