[Ileostomy versus colostomy: which is preferable?]

Abstract

Objective: To investigate whether an ileostomy or colostomy should be preferred in patients requiring temporary double-barrel stoma construction and in whom it is technically possible to construct both types.

Design: Systematic literature search and retrospective comparative analysis.

Method: PubMed, Embase and the Cochrane Library were searched for all literature comparing loop ileostomy and loop colostomy. In addition, we retrospectively analysed 361 patients who had received a loop ileostomy or loop colostomy designed to be temporary between 2009 and 2015 in our hospital, Meander Medisch Centrum, Amersfoort, the Netherlands. Outcome measures were: quality of life, short-term and long-term complications.

Results: The literature search yielded 2092 studies, of which eight were ultimately included. Ileostomy was the preferred stoma in the overall conclusion of six of these studies; no preference was given in the other two. In addition, we analyzed 361 patients from our own hospital in whom a temporary deviating stoma was constructed. 49.6% (n = 179) had a colostomy constructed, the other 50.4% (n = 182) an ileostomy. Significantly fewer stoma retractions (p < 0.01) and incisional hernias (p < 0.01) were reported in the loop ileostomy group. Patients with an ileostomy, however, more often presented with a high-output stoma (p < 0.01) resulting in dehydration (p = 0.03).

Conclusion: A loop ileostomy has a number of advantages over a colostomy. However, in patients with an increased risk of dehydration or compromised renal function, colostomy construction should be seriously considered given the higher complication risk if a high-output stoma develops.