Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Systematic review and meta-analysis.
OBJECTIVE
The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review.


METHODS
Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction.


RESULTS
Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I2 = 0% for the heterogeneity test.


CONCLUSIONS
The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials.
Division of Gastroenterology, Metropolitana University, Santos, SP, Brazil. kfg012@terra.com.br
Katia Ferreira
KF
Güenaga
Suzana Angélica Silva
SA
Lustosa
Sarhan Sydney
SS
Saad
Humberto
H
Saconato
Delcio
D
Matos
D000714:Anastomosis, Surgical; D003125:Colostomy / Q000592:standards*; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D007081:Ileostomy / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D054047:Surgical Stomas / Q000473:pathology; D016896:Treatment Outcome