Preventive intestinal stoma: ileostomy, colostomy. Which option is safer? (meta-analysis and systematic review)

AIM: to compare the incidence of early and late postoperative complications after creation and closure of preventive loop ileostomy or colostomy, and to determine whether one type of intestinal stoma is safer than the other when creating a low colorectal anastomosis.

MATERIALS AND METHODS: the search for scientific papers was conducted in the electronic databases of medical literature PubMed and Elibrary for the past 30 years using the keywords: ileostomy, colostomy; loop ileostomy, loop colostomy; temporary stoma; complications. A systematic review and meta-analysis were conducted, which included 5 randomized and 15 comparative non-randomized studies in English and Russian, which reflected the nature of complications arising from the use and elimination of ileostomies and colostomies. Complications were divided depending on the nature and time of occurrence into early and late. Early complications included: stoma necrosis, stoma bleeding, peristomal dermatitis, stoma retraction, dehydration and parastomal abscess. Late complications included: stoma stricture, stoma prolapse, colorectal anastomotic failure and parastomal hernia. Complications associated with reconstructive surgery with stoma elimination were also analyzed: postoperative hernia in the stoma area, wound infection and hematoma of the anterior abdominal wall, intestinal obstruction. The meta-analysis was performed in accordance with the practice and PRISMA recommendations.

RESULTS: when examining comparative non-randomized studies, it was found that patients with colostomy significantly more often developed late complications such as stoma stricture (odds ratio (OR) = 3.86; 95% Confidence interval (CI): 1.27–11.72; p = 0.02) and stoma prolapse (OR = 2.91; 95% CI: 1.49–5.72; p = 0.002), as well as an early complication in the form of stoma retraction (OR = 2.53; 95% CI: 1.54–4.16; p = 0.0002). Whereas the formation of ileostomy is associated with a higher risk of dehydration (OR = 0.23; 95% CI: 0.12–0.45; p < 0.00001). In contrast, in an analysis of randomized clinical trials (RCTs), the incidence of complications such as stoma prolapse (OR = 8.87; 95% CI: 2.53–31.12; p = 0.0007) and dehydration (OR = 0.32; 95% CI: 0.03–3.14; p = 0.33) were comparable between patients with colostomy and ileostomy. Information on stoma retraction was provided in only one RCT, while stoma stricture was not mentioned at all. In both randomized (OR = 1.19; 95% CI: 0.52–2.75; p = 0.68) and comparative non-randomized studies (OR = 0.56; 95% CI: 0.31–1.02; p = 0.06), the incidence of peristomal dermatitis was slightly higher in patients with ileostomy, but statistical significance was not achieved. The incidence of stoma necrosis, stoma bleeding, parastomal abscess, and parastomal hernia did not differ in both groups. According to the data obtained, complications after reconstructive surgeries associated with the elimination of intestinal stoma are not typical for any of the patient groups.

CONCLUSION: the choice of a preventive stoma is still a subject of debate and discussion. Ileostomy is associated only with a higher risk of dehydration. However, the formation of a loop colostomy is accompanied by a significantly higher incidence of prolapse, retraction and stricture of the stoma, all other complications were comparable. Further randomized clinical trials are needed to confirm the reliability of these differences.

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