Temporary ileostomy versus colostomy for colorectal anastomosis: evidence from 12 studies

OBJECTIVE: To assess the safety and efficacy of temporary ileostomy and temporary colostomy after a low anterior resection for rectal cancer by comparing the postoperative complications, then investigate which type of stoma is better. MATERIAL AND METHODS: Studies comparing temporary ileostomy with colostomy for colorectal anastomosis were searched. The rates of complications (i.e., clinical anastomotic leak or fistula, stoma prolapse, parastomal hernia, wound infection related to stoma closure, obstruction following stoma closure, and skin trouble) were pooled and compared using a meta-analysis. The risk ratios (RRs) were calculated with 95% confidence intervals (CIs). RESULTS: The study included five randomized controlled trials (RCTs) and seven non-randomized studies involving 1687 patients. The meta-analysis of the RCTs demonstrated a lower risk of stoma prolapse (RR 0.15; 95% CI: 0.04-0.48) in the temporary ileostomy group. Meta-analysis of the non-randomized studies showed a lower risk of stoma prolapse and wound infection after stoma closure in the temporary ileostomy group (both p < 0.05). CONCLUSIONS: Temporary ileostomy has a minor impact on patients; we endorse temporary ileostomy over colostomy after a low anterior resection for rectal cancer.