Background and aims: De-functioning loop ileostomies are used currently in anterior resection to reduce the consequences of anastomotic leak. However, this practice remains controversial as the complication associated with the de-functioning stoma has been overlooked. The objectives of this paper were to study the complication associated with de-functioning loop ileostomy in the patient undergoing an anterior resection.
Method: Patient sample identification obtained from local colorectal registry and data reviewed retrospectively. Only anterior resection with or without de-functioning loop ileostomy for the indication of rectal cancer or pre-cancerous polyps were included. 150 patients satisfied the inclusion criteria. Statistical analysis of Chi-square test was applied for twogroup comparisons of categorical data and Mann Whitneyfor continuous numerical variables.
Results: Overall, 50% of 74 patients in the stoma group had stoma-related complication either acutely or later that resulted in unplanned re-admission with re-admission rate of 17.6%. Closure rate was 77%, with a mean interval of 7.4 months. A further 28% (16 of 57) of the reversed groupexperienced complications. Combined length of stay after anterior resection and reversal surgery was 19.3 days vs. 8.1 days in the non-stoma group (p=0.001).
Conclusion: The creation of de-functioning loop ileostomy is associated with a significantly increased risk of stoma-related morbidity with low anterior resection. The perceived benefits and risks of routine creation of de-functioning loop ileostomy in anterior resection should be reconsidered while planning for surgery and only selective of suitable candidates that are of high risk of severe anastomotic leak.
Bowel cancer statistics. Cancer Research UK. 2021 (accessed on 27 April 2021). Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer.
Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg. 2004;240(2):260-8. Available from: https://doi.org/10.1097/01.sla.0000133185.23514.32.
Karanjia ND, Schache DJ, North WR, Heald RJ. ‘Close shave’ in anterior resection. Br J Surg. 1990;77(5):510-2. Available from: https://doi.org/10.1002/bjs.1800770512.
Cong ZJ, Hu LH, Bian ZQ, et al. Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One 2013;8(9):e75519. Available from: https://doi.org/10.1371/journal.pone.0075519.
van Helsdingen CP, Jongen AC, de Jonge WJ, Bouvy ND, Derikx JP. Consensus on the definition of colorectal anastomotic leakage: a modified Delphi study. World J Gastroenterol. 2020;26(23):3293-3303. Available from: https://doi.org/10.3748/wjg.v26.i23.3293
Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96(5):462-72. Available from: https://doi.org/10.1002/bjs.6594.
Austin SR, Wong YN, Uzzo RG, Beck JR, Egleston BL. Why summary comorbidity measures such as the Charlson Comorbidity Index and Elixhauser Score work. Med Care. 2015;53(9):e65-72. Available from: https://doi.org/10.1097/MLR.0b013e318297429c.
Baker ML, Williams RN, Nightingale JM. Causes and management of a high-output stoma. Colorectal Dis. 2011;13(2):191-7. Available from: https://doi.org/10.1111/j.1463-1318.2009.02107.x.