Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial

Background: The consequences of leakage from low colorectal or coloanal ana stomoses are reduced by the use of a loop stoma to divert the faecal stream . Controversy continues as to whether loop ileostomy (LI) or loop transvers e colostomy (LTC) is the optimal method of defunctioning such anastomoses. Methods: Patients requiring defunctioning following anterior resection and total mesorectal excision were randomized to receive either LI or LTC. Comp arison was made between the groups regarding the difficulty of stoma format ion and closure, the recovery after stoma closure and stoma-related complic ations. The minimum follow-up after stoma closure was 6 months (median 36 m onths). Results: Between October 1995 and August 1999, 70 patients were randomized (LTC 36, LI 34) of whom 63 underwent stoma closure (LTC 31, LI 32). There w ere no significant differences in the difficulty of formation or closure, o r in the postoperative recovery between the groups. However, there were ten complications related directly to the stoma in the LTC group: faecal fistu la (one patient), prolapse (two), parastomal hernia (two) and incisional he rnia during follow-up (five). None of these complications occurred in the L I group. Conclusion: In this randomized study, the frequency of herniation before or after colostomy closure supports the choice of LI as a method of defunctio ning a low anastomosis. Both methods appear to provide satisfactory protect ion for the low anastomosis.