title: Diversion stoma after colorectal surgery: loop colostomy or ileostomy?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, RWTH Aachen, University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany. cklink@ukaachen.de
authors.forename: Christian D
authors.initials: CD
authors.lastname: Klink
authors.forename: Kosta
authors.initials: K
authors.lastname: Lioupis
authors.forename: Marcel
authors.initials: M
authors.lastname: Binnebösel
authors.forename: Daniel
authors.initials: D
authors.lastname: Kaemmer
authors.forename: Ivanna
authors.initials: I
authors.lastname: Kozubek
authors.forename: Jochen
authors.initials: J
authors.lastname: Grommes
authors.forename: Ulf P
authors.initials: UP
authors.lastname: Neumann
authors.forename: Marc
authors.initials: M
authors.lastname: Jansen
authors.forename: Stefan
authors.initials: S
authors.lastname: Willis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000379:methods*; D003125:Colostomy / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D054047:Surgical Stomas / Q000009:adverse effects; D055815:Young Adult