Temporary ileostomy versus temporary colostomy: A meta-analysis of complications

OBJECTIVE: To compare the complications of temporary diverting ileostomy with those of temporary colostomy for patients with colorectal diseases. METHODS: Two independent researchers conducted a systematic search for randomized controlled trials (RCTs) comparing temporary ileostomy with temporary colostomy in MEDLINE, the Cochrane database, evidence-based medicine reviews and the American College of Physicians journal club, as well as relevant reference lists in journal articles. Five RCTs were found and included in this meta-analysis. All complications were abstracted and compared between groups. All complications were also assessed using tests of statistical heterogeneity, pooling of risk ratios using Mantel-Haenszel fixed effects and DerSimonian and Laird random effects. Clinical heterogeneity was investigated by examining the methodology and selection of patients described in each trial. RESULTS: Temporary colostomy was significantly more likely to cause stoma complications in colorectal cancer patients undergoing elective resections, and also more likely to cause infectious and wound complications. Temporary ileostomy tended to cause more post-closure surgical complications. CONCLUSIONS: There is not yet a strong case for the superiority of one temporary diverting stoma over another for all colorectal patients. In this regard, a large, well-conducted RCT is still needed.