Divertive ileostomy in left-sided colorectal resections: retrospective analysis and literature review

Skoryi D., Ilin I., Trehub Y.

Summary. Introduction. Colorectal anastomosis leakage (AL) is a major devastating complication in colon and rectal surgery. The frequency of AL reaches 11% after anterior rectal resections. A variety of techniques have been proposed for reducing the risk of AL in colorectal surgery. One of them is the proximal diversion of the fecal stream by the application of a divertive stoma. Materials. We performed a retrospective analysis of a series of 73 patients who underwent different types of reconstructive resections of the left colon and rectum with the application of divertive stomas for malignant and benign pathology of the rectum, colon, and internal female genital organs in 2018–2020 in CNPE «Regional Center of Oncology», Kharkiv. Results. The frequency of AL was 4.1%, clinically significant — 2.7%. Ileostomy was chosen for diversion in 72 cases. The average time to stoma closure was 117 days. The proportion of stoma-free patients at the time of the analysis was 86.3%. 76.7% of the stomas were closed within an interval of 6 months. 6.1% of patients experienced major postoperative complications following stoma closure. Conclusions. Divertive stomas effectively reduce the incidence of clinically significant AN in left-sided colorectal resections. An ileostomy is preferred over a colostomy. The routine use of divertive ileostomas in practice is easy to implement and makes it possible to reproduce the results of landmark studies and retrospective analyzes of large centers.

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