Ileostomy and Colostomy in the Prevention and Treatment of Postoperative Complications in Colorectal Cancer

Abstract

Introduction. To evaluate the efficiency of ileostomy and colostomy as a method of preventing and treating postoperative intra-abdominal complications in patients with colorectal cancer.

Materials and Methods. The treatment outcomes of 224 patients operated for colorectal cancer with localization in the left colon. The surgery was performed in the North-Western State Medical University named after I.I. Mechnikov in the period from 2014 to 2022. From this group we selected patients who had an ileostomy and colostomy (n = 57), protective colostomy (n = 24), protective ileostomy (n = 26), and therapeutic or deviating stoma stoma (n = 7).

Results. The study aimed to assess how the formation of a protective ileostomy or colostomy affects the development of intra-abdominal complications in the postoperative period in surgical treatment of colorectal cancer, and to determine the efficiency of postoperative stoma formation for prevention of peritonitis progression in case of interintestinal anastomosis failure. Postoperative intra-abdominal complications were observed during the formation of both protective colostomy and ileostomy, however, there were no statistically significant data on the dependence of complications on the type of stoma (p > 0.05). There were no unfavorable outcomes. The treatment of postoperative complications was complex. The most effective method of treatment of clinically significant failure of the colonic anastomosis was complete disconnection of the intestine by colostomy or ileostomy. These operations helped to control peritonitis. The dependence of complications development on the timing of stoma closure was also evaluated, showing that in the early postoperative phase (9-13 days) stoma removal leads to an increased incidence of complications associated with colonic anastomosis failure (p < 0.05).

Conclusion. Ileo- and colostomies have equal efficacy in both prevention and treatment of complications associated with colonic anastomosis failure, fully disconnecting the underlying bowel (p > 0.05). The selection of the type of intestinal stoma should be primarily related to the safety of formation in each case. Deviation stoma formation in case of anastomosis failure and associated complications is an effective treatment tool. In early postoperative period (9-13 days) stoma removal leads to an increased incidence of complications associated with colonic anastomosis failure (p < 0.05).