Loop ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy

Both loop ileostomy (LI) and loop transverse colostomy (LTC) could achieve absolute fecal diversion and have several advantages. This study compared LI and LTC following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy.

Between January 2009 and December 2016, 186 patients who underwent laparoscopic low anterior resection for rectal cancer and loop ostomy were included. All patients received preoperative neoadjuvant chemoradiotherapy. Of these, 77 underwent LI and 109 underwent LTC. Demographic characteristics, operative details, and complications were analyzed.

In the fecal diversion period, the LTC group showed significantly less dermatitis (p = 0.001) and electrolyte disturbance (p = 0.002), while LI group showed significantly shorter time to first defecation (p = 0.006) and lower incidence of parastomal hernia (p = 0.014). In the stoma closure period, a significantly higher incidence of wound infection was found in LTC group (p = 0.001).

Both LI and LTC have advantages and disadvantages. For its lower wound infection rate, lower incidence of parastomal hernia, and shorter time to first defecation, LI is recommended for all patients except those with potential electrolyte disturbance and sensitive skin.