Protective Ileostomy After Low Anterior Resection for Rectal Cancer: Modifying the Clinical Course of Anastomotic Leakage at the Cost of Stoma-Related Morbidity.

Authors

Mustafa Yılmaz, Mahsum Barçin, Cumhur Özcan, Uğfe Kuyucuoğlu Özkan, Hüseyin Oğuzhan İnan, Hilmi Bozkurt, Tahsin Çolak

Published in

The American surgeon. Pages 31348261471475. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

BackgroundProtective ileostomy (PI) after low anterior resection may not prevent anastomotic leakage (AL) but may lessen its clinical consequences, while adding stoma-related morbidity. This study evaluated the association of PI with the clinical course of AL and stoma-related outcomes.MethodsPatients who underwent total mesorectal excision with low anterior resection after neoadjuvant therapy were retrospectively reviewed and grouped as LAR alone (n = 10) or LAR + PI (n = 74). Main outcomes were AL severity, management, leak-related mortality, AL incidence, and PI-related morbidity, including closure outcomes.ResultsAmong 84 patients, AL occurred in 5.9% (5/84), without a significant difference (LAR 10.0% vs LAR + PI 5.4%; P = 0.478). Reoperation was required in one LAR patient and two PI patients; two PI patients were managed with percutaneous drainage. Leak-related mortality occurred in one LAR patient and none in the PI group. Length of stay was longer with PI (median 10.0 days, interquartile range [IQR] 9.0-11.0) than without PI (7.5 days, IQR 6.0-8.0; P < 0.001). Protective ileostomy-related complications included outlet obstruction (9.5%), surgical site infection (4.1%), bleeding (4.1%), and parastomal hernia (2.7%). Closure was achieved in 90.5% after a median of 180 days (IQR 142.5-273); post-closure complications included obstruction (9.2%), infection (4.6%), small-bowel leak (4.6%), and bleeding (1.5%).DiscussionProtective ileostomy was not associated with a statistically significant reduction in anastomotic leakage incidence but appeared to be associated with a more favorable clinical course when leakage occurred, including lower mortality and the feasibility of less invasive management.

PMID:
42498704
Bibliographic data and abstract were imported from PubMed on 25 Jul 2026.

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