Diversion stoma after colorectal surgery: loop colostomy or ileostomy?

作者：Klink Christian D^*; Lioupis Kosta; Binneboesel Marcel; Kaemmer Daniel; Kozubek Ivanna; Grommes Jochen; Neumann Ulf P; Jansen Marc; Willis Stefan

来源：International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery, 2011, 26(4): 431-436.

DOI：10.1007/s00384-010-1123-2

• Ileostomy
• Transverse colostomy
• Colorectal resection
• Fecal diversion
• Loop stoma

The total rate as well as the clinical outcome of anastomotic leakage in colorectal and coloanal anastomosis necessitates a loop stoma for fecal diversion. The aim of this study was to determine the outcome of loop transverse colostomy compared to loop ileostomy as a temporary defunctioning stoma following colorectal surgery with colorectal or coloanal anastomosis.
Data of 200 patients between January 2003 and January 2009 were analyzed in this two-center study to determine the surgical outcome in patients with loop colostomy (n = 100) in comparison to loop ileostomy (n = 100) for fecal diversion including outcome of stoma creation and complication rates during stoma reversal.
During stoma placement, dermatitis and renal insufficiency occurred significantly more often in the loop ileostomy group than in the loop transverse colostomy group (15% vs. 0%; p < 0.001 and 10% vs. 1%; p = 0.005). During stoma reversal, wound infection occurred significantly more often in the loop transverse colostomy group than in the loop ileostomy group (27% vs. 8%; p < 0.001). Time to first defecation was significantly shorter in the loop ileostomy group after both placement and reversal (4 +/- 2 vs. 2 +/- 1; p < 0.001 and 3 +/- 2 vs. 2 +/- 1; p < 0.001). Hospital stay was significantly shorter in the loop ileostomy group than in the loop transverse colostomy group after stoma closure (18 +/- 15 vs. 13 +/- 6; p < 0.001).
Both methods provide a good operative outcome with low complication rates. We do recommend the loop ileostomy in all patients in which dehydration is not to be expected since wound infection rate is lower and hospital stay is shorter during stoma reversal.

• 出版日期2011-4