Intervention Review

Ileostomy or colostomy for temporary decompression of colorectal anastomosis

  1. Katia F Güenaga1,*,
  2. Suzana AS Lustosa2,
  3. Sarhan S Saad3,
  4. Humberto Saconato4,
  5. Delcio Matos5

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 21 SEP 2006

DOI: 10.1002/14651858.CD004647.pub2

Database Title

Additional Information

How to Cite

Güenaga KF, Lustosa SAS, Saad SS, Saconato H, Matos D. Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004647. DOI: 10.1002/14651858.CD004647.pub2.

Author Information

  1. 1

    Federal University of São Paulo, Surgical Gastroenterology Department, Santos, São Paulo, Brazil

  2. 2

    Centro Universitário de Volta Redonda - RJ, Surgery, Volta Redonda, Rio de Janeiro, Brazil

  3. 3

    Universidade de São Paulo - Escola Paulista de Medicina, Surgery, São Paulo, São Paulo, Brazil

  4. 4

    Federal University of Rio Grande do norte, Department of Medicine, São Paulo, Vila Clementino, Brazil

  5. 5

    Universidade Federal de São Paulo, Brazilian Cochrane Centre, São Paulo, São Paulo, Brazil

*Katia F Güenaga, Surgical Gastroenterology Department, Federal University of São Paulo, Rua Dr. Vitor de Lamare, 33 apto. 21, Santos, São Paulo, 11045-340, Brazil. kfg012@terra.com.br.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The use of loop ileostomy or loop transverse colostomy represents an important issue in colorectal surgery. Despite a slight preference for a loop ileostomy as a temporary stoma, the best form for temporary decompression of colorectal anastomosis still remains controversial.

Objectives

To assess the evidence in the use of loop ileostomy compared with loop transverse colostomy for temporary decompression of colorectal anastomosis, comparing the safety and effectiveness.

Search methods

We identified randomised controlled trials from MEDLINE, EMBASE, Lilacs, and the Cochrane Central Register of Controlled Trials. Further, by hand-searching relevant medical journals and proceedings from major gastroenterological congresses. We did not limit the seaches regarding date and language.

Selection criteria

We assessed all randomised clinical trials, that met the objectives and reported major outcomes: 1. Mortality; 2. Wound infection; 3. Time of formation of stoma; 4. Time of closure of stoma; 5. Time interval between formation and closure of stoma; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction.

Data collection and analysis

Details of the randomisation, blinding, whether an intention-to-treat analysis was done, and the number of patients lost to follow-up was recorded. For data analysis the relative risk and risk difference were used with corresponding 95% confidence interval; fixed effect was used for all outcomes unless incisional hernia (random effect model). Statistical heterogeneity in the results of the meta-analysis was assessed by inspection of graphical presentation (funnel plot) and by calculating a test of heterogeneity.

Main results

Five trials were included with 334 patients: 168 to loop ileostomy group and 166 to loop transverse colostomy group. The continuous outcomes could not be measured because of the lack of the data. The outcomes stoma prolapse had statistical significant difference: p=0.00001, but with statistical heterogeneity, p=0,001. When the sensitive analysis was applied excluding the trials that included emergencies surgeries, the result had a discreet difference: p = 0.02 and Test for heterogeneity: chi-square = 0.78, df = 2, p = 0.68, I2=0%.

Authors' conclusions

The best available evidence for decompression of colorectal anastomosis, either use of loop ileostomy or loop colostomy, could not be clarified from this review. So far, the results in terms of occurrence of postoperative stoma prolapse support the choice of loop ileostomy as a technique for fecal diversion for colorectal anastomosis, but large scale RCT's is needed to verify this.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Ileostomy or colostomy for temporary decompression of colorectal anastomosis

Anastomotic leakage after left-sided colorectal resections is a serious complication, which leads to increase morbidity and mortality and prolonged the hospital stay. Proximal fecal diversion may limit the consequences of anastomotic failure. It remains controversial whether a loop ileostomy or a loop transverse colostomy is a better form of fecal diversion. This review included five randomised trials (334 patients), comparing loop ileostomy (168 patients) and loop colostomy (166 patients) used to decompression of a colorectal anastomosis. Except for stoma prolapse, none of the reported outcomes reported were statistically or clinically significant. Continuous outcomes, such as lenght of hospital stay, was not included due to insufficient data reported in the primary studies.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

為結直腸吻合暫時減壓的迴腸造口或結腸造口

在大腸癌手術,用環形迴腸造口或環形橫結腸造口代表一個重要問題.儘管略有偏好環形迴腸造口,結直腸吻合後,最好的暫時減壓形式仍然存在爭議

目標

評估,比較結直腸吻合後的暫時性減壓,使用環狀迴腸造口和橫向環狀結腸造口,比較它們安全性和有效性

搜尋策略

我們從MEDLINE，EMBASE，Lilacs，和 Cochrane Central Register of Controlled Trials定義隨機對照試驗.此外，從主要的腸胃病學會議程序,通過手工檢索相關的醫學刊物.我們沒有限制搜索有關的日期和語言.

選擇標準

我們評估了所有隨機臨床試驗，認為達到了目標，並報告的主要結果： 1.死亡率; 2.傷口感染;3.造口的形成時間;4.造口的關閉時間;5.造口關閉和形成的時間間隔;6.造口脫垂;7.造口收縮;8.造口旁疝氣;9.造口旁廔管;10.狹窄;11.壞死;12.皮膚刺激;13.腸阻塞; 14.腸滲漏; 15.再手術; 16.病人適應; 17.住院長度18.結直腸吻合口裂開; 19.切口疝氣; 20.術後腸阻塞.

資料收集與分析

隨機的詳細情況,雙盲,不論意向治療分析是否完成、後續沒有進行追蹤的病患是否有紀錄對於數據分析的相對風險和風險差被用於相應的95%信賴區間.除了切口疝氣,固定效應被用於所有的結果(隨機效應模型)統計異質性的結果分析評估檢查圖形顯示(funnel plot漏斗圖)，並通過計算測試的異質性

主要結論

五個試驗334例包括:168例環狀迴腸造口組和166例環狀橫向結腸造口術組,連續性的結果因為缺乏數據,無法被測量.造口脫垂的結果有顯著性差異：p = 0.00001,但是與統計非均勻性p = 0,001.當敏感分析適用於排除試驗，其中包括緊急手術,結果有一個謹慎的區別: p = 0.02 和異質性試驗:chisquare = 0.78, df = 2, p = 0.68, I2 = 0%.

作者結論

結直腸吻合的減壓最佳的有效證據,要使用環狀迴腸造口或環狀結腸造口,都無法在這個審查中弄清楚.到目前為止，發生術後造口脫垂結果,支持選擇環狀迴腸造口術，做為結直腸吻合術的糞便改道技術.但需要大規模的隨機對照試驗驗證這一點

翻譯人

本摘要由國泰綜合醫院張世昌翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

左半結腸切除術後的吻合滲漏是一種嚴重的併發症,它會導致併發率和死亡率的增加以及延長住院.近端糞便會導致吻合失敗的後果.環狀迴腸造口或橫向環狀結腸造口是一個較好的糞便分流形式,仍存在爭議.這項審查包括5個隨機試驗(334例)，比較環狀迴腸造口術(168例)和環狀結腸造口(166例),用於結直腸吻合的減壓.除了脫垂,沒有結果的報告被報告出來有統計學或臨床意義. 連續性的成果，如住院長度並沒有被列入因資料不足而報告的主要研究

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