Loop ileostomy versus transverse colostomy as a covering stoma after anterior resection for rectal cancer


  • Saied Hosny Bendary Department of Surgical Oncology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
  • Abd Elfatah T. El sheikh Department of Surgical Oncology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
  • Mahmoud Kamal Ramadan Department of Surgical Oncology, Damanhur general Hospital, Al Beheira, Egypt




Complication, Colorectal cancer, Loop ileostomy, Rectal cancer, Restorative resection, Transverse colostomy


Background: Most colorectal cancer occurs due to lifestyle and increase age with only a minority of cases associated with underlying genetic disorders and environmental factors enables us to move in the direction of a complete assessment of disease risk. The objective of the present study was to compare between two different types of diverting stoma (loop ileostomy and transverse colostomy) as regard immediate and remote complications in patient with rectal cancer treated by restorative resection.

Methods: A prospective randomized comparative clinical study was conducted on 50 patients who underwent anterior resection and low anterior resection for rectal cancer divided into two groups: Group I consisted of 25 patients who underwent by loop ileostomy. Group II consisted of 25 patients who underwent by loop transverse colostomy. All patients attended to surgical oncology unit of Sayed Galal hospital, Al Azhar University, Cairo, Egypt during the period from October 2018 to October 2019. Full history, routine, physical examination, routine and imaging investigations were done.

Results: 80% and 84% of loop ileostomy and transverse colostomy patients had anterior resection, respectively with no statistically significant differences between the two studied groups regarding anterior resection. Patient who treated by loop ileostomy had deceased time of closure (5.2±0.25 weeks) and stay in hospital (5.16±1.65 and 3.29±0.55 days) than those treated by transverse colostomy (9.6±0.37 weeks) and (7.44±2.58 and 6.03±1.97 days) respectively.

Conclusions: Egyptians have unique tumor characters and behavior, and different compliance with treatment regimens. Multicenter prospective studies, as well as evolving Egyptian treatment guidelines are needed to address this.

Author Biographies

Saied Hosny Bendary, Department of Surgical Oncology, Faculty of Medicine, Al Azhar University, Cairo, Egypt

Surgical oncology department, Faculty of medicine, Al Azhar University, Cairo, Egypt

Abd Elfatah T. El sheikh, Department of Surgical Oncology, Faculty of Medicine, Al Azhar University, Cairo, Egypt

Surgical oncology department, Faculty of medicine, Al Azhar University, Cairo, Egypt


Gohar SF, Al Hassanin SA, El-Assal M, Hussein AM. Clinico-epidemiology study of colorectal cancer in Menoufia University Oncology Department. Age. 2015;44(5):21-5.

Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015;58(1):122-140.

Salvadalena G, Hendren S, McKenna L, Muldoon R, Netsch D, Paquette I, et al. WOCN Society and AUA position statement on preoperative stoma site marking for patients undergoing urostomy surgery. J Wound Ostomy Continence Nurs. 2015;42(3):253-6.

Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683-91.

Liu Y, Luan L, Wang X. A randomized Phase II clinical study of combining panitumumab and bevacizumab, plus irinotecan, 5-fluorouracil, and leucovorin (FOLFIRI) compared with FOLFIRI alone as second-line treatment for patients with metastatic colorectal cancer and KRAS mutation. Onco Targets Therap. 2015;8:1061-8.

Shabbir MN, Memon ZA, Nizami M, Khanzada RI. Colostomy related complications. Pakistan J Surg. 2014;24(2):102-4.

Manzenreiter L, Spaun G, Weitzendorfer M, Luketina R, Antoniou SA, Wundsam H, et al. A proposal for a tailored approach to diverting ostomy for colorectal anastomosis. Minerva Chirurgica. 2018;73(1):29-35.

Ali AM. Loop transverse colostomy versus loop ileostomy after low and ultralow anterior resection. Int Surg J. 2018;5(16)33-9.

Kawada K, Hasegawa S, Wada T, Takahashi R, Hisamori S, Hida K, et al. Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis. Surgical Endoscop. 2017;31(3):1061-9.

Sun X, Han H, Qiu H, Wu B, Lin G, Niu B, et al. Comparison of safety of loop ileostomy and loop transverse colostomy for low-lying rectal cancer patients undergoing anterior resection: A retrospective, single institute, propensity score-matched study. J BUON. 2019;24(1):123-9.

Kaidar-Person O, Person B, Wexner SD. Complications of Construction and Closure of Temporary Loop ileostomy. J Am Coll Surg. 2005;20(1):759-73.

Kumar V L, Sathyanarayana KV. A comparative study between Santulli ileostomy and loop ileostomy. (IOSR-JDMS). 2016;15:36-40.

Lindgren R, Hallbook O, Rutegard J, Sjodahl R, Matthiessen P. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum. 2011;54:41-7.

Fazekas B, Hendricks J, Smart N, Arulampalam T. The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection. Ann R Coll Surg Engl. 2017;99:319-24.

Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg. 1998;85:76-9.

Metcalf MA, Dozois RR, Beart RW, Wolff BG. Temporary ileostomy for ileal pouch anal anastomosis: Functions and complications. Dis Colon Rect. 1986;29:300-3.

Rullier E, Letoux N, Laurant C, Garrelon JL, Parneix M, Saric J. Loop ileostomy vs loop colostomy for defunctioning low anastomosis during rectal cancer surgery. World J Surg. 2001;25:274-7.

Klink CD, Lioupis K, Binnebosel M, Kaemmer D, Kozubek I, Grommes J. Diversion stoma after colorectal surgery: loop colostomy or ileostomy. Int J Colorectal Dis. 2011;26:431-6.

Whitehead A, Cataldo PA. Technical Considerations in Stoma Creation. Clin Colon Rectal Surg. 2017;30:162-71.

Arthur C, Guyton JEH. Textbook of Medical Physiology (11th edn). Philadelphia, Penn¬sylvania: Saunders Elsevier; 2006.

Bryant CL, Lunniss PJ, Knowles CH. Anterior resection syndrome. Lancet Oncol. 2012;13:403-8.

Khoo RE, Cohen MM, Chapman GM. Loop ileostomy for temporary fecal diversion. Am J Surg. 1994;167:519-22.

Riesener KP, Lehnen W, Hofer M, Kasperk R, Braun JC, Schumpelick V. Morbidity of ileostomy and colostomy closure: impact of surgical technique and perioperative treatment. World J Surg. 1997;21(1):103-8.

Senapati A, Nicholls RJ, Ritchie JK. Temporary loop ileostomy for restorative proctocolectomy. Br J Surg. 1993;80:628-30.

van de Pavoordt HDWM, Fazio VW, Jagleman DG. The outcome of loop ileostomy closure in 293 cases. Int J Colorect Dis. 1987;2:214-7.

Chen F, Stuart M. The morbidity of defunctioning stomata. Aust NZJ Surg. 1996;66:218-21.






Original Research Articles