Evaluation of diverting ileostomy in laparoscopic low anterior resection for rectal cancer.

BACKGROUND: Diverting ileostomy is believed to mitigate the effects of anastomotic complications in low anterior resections (LAR) for rectal cancer. However, there are no data about the effects of diverting ileostomy on the outcomes of laparoscopic LAR METHODS: We retrospectively reviewed the medical records of 77 consecutive rectal cancer patients who had undergone laparoscopic LAR with (n = 23) or without (n = 54) diverting ileostomy. The patients' data were recorded and supplemented on short-term follow-up visits and included standard demographics, operative procedure, location of the cancer, and final pathologic diagnosis. We noted length of hospitalisation, complications, and time interval from ileostomy creation to closure. Morbidity and mortality were also included.

RESULTS: Surgical intervention requiring anastomotic leakage occurred in three patients who underwent laparoscopic LAR without diverting ileostomy. The anastomosis level of patients who underwent laparoscopic LAR with diverting ileostomy was significantly lower than that of patients who underwent laparoscopic LAR without diverting ileostomy (p < 0.05).

CONCLUSION: Anastomosis level and total mesorectal excision are the main factors for creation of diverting ileostomy in laparoscopic LAR Laparoscopic LAR without diverting ileostomy could be selectively performed. Our study provides a basis for further prospective randomised studies on the role of diverting ileostomy in LAR.