Loop ileostomy versus loop colostomy as temporary deviation after anterior resection for rectal cancer

Purpose Construction of a temporary stoma is a common adjunct to low anterior resection for rectal cancer and can be accomplished either with loop ileostomy (LI) or loop colostomy (LC) with the question of the most appropriate one still remaining controversial. The aim of this study is to compare stoma-related morbidity between the two groups. Methods A retrospective review was conducted including 148 consecutive patients (LI: 55/LC: 93) who underwent anterior resection for rectal cancer between January 2004 and December 2018 in our department. Time interval between low anterior resection and stoma reversal was similar for both groups. Comparison between the two groups was made regarding stoma-related morbidity after stoma construction and after stoma reversal, respectively. Results A total number of 17 patients suffered from complications after the construction of a protective LI compared with 25 patients after the construction of a LC (LI vs LC: 17/55 (30.1%) vs 25/93 (26.9%);p = 0.59). The most common morbidity noted in both groups before stoma closure was parastomal hernia, with the difference being statistically not significant (LI vs LC: 11/55 (20%) vs 21/93 (22.6%);p = 0.84). However, patients with LI suffered from significantly more peristomal skin irritations compared with the patients with LC (LI vs LC: 5/55 (9.1%) vs 1/93 (1.1%);p = 0.027). Overall morbidity rate after stoma closure was found to be comparable in both groups (LI vs LC: 7/37 (18.9%) vs 6/64 (9.4%);p = 0.16). The most common complication after stoma reversal was wound infection (LI vs LC: 5/37 (13.5%) vs 5/64 (7.8%);p = 0.49). Conclusion With the exception of a higher rate of skin irritation after LI construction, all other postoperative outcomes were found to be comparable in both study groups. Further randomized clinical trials are required to verify these findings. The study was registered in the German Registry for Clinical Trials (DRKS00020766, date of registration: 11.02.2020).