Protective defunctioning stoma in low anterior resection for rectal carcinoma

BACKGROUND: Anastomotic leak is a serious complication of resection for low rectal carcinoma. METHODS: Data from a prospective multicentre study conducted between January 2000 and December 2001 were analysed to determine the early outcome after low anterior resection in patients with and without a protective stoma. The morbidity and mortality rates associated with ileostomy and colostomy closure were compared. RESULTS: Eight hundred and eighty-one (32.3 per cent) of 2729 patients received a protective stoma after low anterior resection. Overall anastomotic leak rates were similar in patients with or without a stoma (14.5 versus 14.2 per cent respectively). The incidence of leaks that required surgical intervention was significantly lower in those with a protective stoma (3.6 versus 10.1 per cent; P < 0.001), as was the mortality rate (0.9 versus 2.0 per cent; P = 0.037). Logistic regression analysis showed that provision of a protective stoma was the most powerful independent variable for avoiding an anastomotic leak that required surgical correction. Seven hundred and twenty-four of the 881 patients who received a stoma were followed up. The overall postoperative morbidity associated with stoma closure was significantly lower for colostomy than for ileostomy (15.3 versus 22.4 per cent; P = 0.031). CONCLUSION: A protective stoma reduced the rate of anastomotic leakage that required surgical intervention, and mitigated the sequelae of such leakage. Colostomy closure was associated with less morbidity than closure of an ileostomy.