[Ileostomy--cecal fistula--colostomy--which is the most suitable fecal diversion method with reference to technique, function, complications and reversal?]

Abstract

In the literature the question as to what constitutes the most suitable faecal diversion procedure continues to be controversial. Between 1989 and 1994 at the Surgical Department of the University of Erlangen a total of 464 patients received intestinal stomas for a wide range of different indications. Of these procedures 41.6% (n = 193) were temporary diversion stomas (ileum n = 170, transverse colon n = 16, jejunum n = 4, sigmoid n = 2, ascending colon n = 1). Subsequently, 7.8% of the loop ileostomies and 9.7% of the loop colostomies needed revision for early or late complications. After reversal surgery none of the loop colostomies, but 2.5% of the loop ileostomies, developed complications needing operative treatment. On the basis of our own experience and the data reported in the literature it may be stated that both loop ileostomy and loop colostomy are effective faecal diversion procedures which, with appropriate bowel preparation and a meticulous surgical technique, can be reversed with a low incidence of complications. Both procedures, however, require careful preoperative planning, operative technique and care if complications are to be avoided. Used simply for the creation of a stoma, the laparoscopic approach offers certain advantages.