A single-center retrospective study of prophylactic loop ileostomies and transverse end colostomies after laparoscopic radical resection for rectal cancer: a comparison of safety and functional outcomes

OBJECTIVE: This study compared the safety and functional outcomes of prophylactic loop ileostomy (LI) versus transverse end colostomy (TEC) after laparoscopic radical resection for rectal cancer. METHODS: In this single-center retrospective study, 171 patients requiring a prophylactic stoma were divided into LI (n = 93) and TEC (n = 78) groups. Primary endpoints were anastomotic leakage (AL) and AL-related reoperation rates within 3 months. RESULTS: The AL rate was comparable between groups (LI 2.2% vs TEC 1.3%, p = 1.0). However, all leaks in the LI group required reoperation, versus none in the TEC group. The overall complication rate was higher in the LI group (39% vs 15%, p < 0.05), driven mainly by electrolyte disturbances (32% vs 11%, p < 0.05). LI was associated with shorter operative times for both initial stoma creation and subsequent reversal (both p < 0.05). Among the 144 patients who underwent stoma reversal, incisional hernia occurred only in the LI group (4/78 vs 0/66, p = 0.12). CONCLUSION: TEC is a non-inferior alternative associated with a lower reoperation risk for AL and fewer metabolic complications, whereas LI offers shorter operative times. The choice depends on weighing procedural efficiency against long-term stoma-related risks.