Technique for constructing a totally defunctioning loop transverse colostomy that functions as an end colostomy
Description of a surgical technique and outcomes from a single-center clinical series
DOI:
https://doi.org/10.67572/4w1qjq66Keywords:
protective stoma, transverse colostomy, anterior rectal resection, anastomotic leakageAbstract
Background: Defunctioning stomas are a well-established strategy for reducing the clinical consequences of anastomotic leakage following anterior rectal resection. However, conventional loop stomas do not always achieve complete diversion of the fecal stream from the distal bowel.
Aim: To describe a modified technique for constructing a loop transverse colostomy that functions as an end colostomy by achieving complete diversion of the distal bowel, as well as the technique for its subsequent reversal, and to evaluate its clinical outcomes.
Materials and Methods: A retrospective–prospective study was conducted in patients who underwent anterior rectal resection at the First Department of Surgery, General Hospital “Princess Clementine”, between 2013 and 2025. Two consecutive patient series in which the modified transverse colostomy technique was applied were analyzed. The incidence of anastomotic leakage, postoperative complications, mortality, and outcomes following stoma reversal were evaluated.
Results: Complete diversion of the fecal stream from the distal bowel was achieved in all patients who underwent the modified protective transverse colostomy. Anastomotic leakage occurred in 1 of 44 patients (2%). Stoma reversal was performed in 33 patients (75%), of whom 22 (66%) experienced no postoperative complications. No cases of anastomotic leakage were observed following restoration of bowel continuity. The most common complications after stoma reversal were surgical site infection, transient postoperative ileus, and incisional hernia.
Conclusion: The proposed modification of the loop transverse colostomy provides reliable diversion of the distal bowel and allows safe restoration of bowel continuity without the need for extensive bowel resection. The technique was associated with a low incidence of anastomotic leakage and favorable early postoperative outcomes, representing a promising alternative when a protective colostomy is indicated.
Keywords: protective stoma; transverse colostomy; anterior rectal resection; anastomotic leakage.
References
1. Alia Whitehead, Peter A Cataldo. Technical Considerations in Stoma Creation. Clinics in Colon and Rectal Surgery. 2017; 30(3):162–171. https://doi.org/10.1055/s-0037-1598156 DOI: https://doi.org/10.1055/s-0037-1598156
2. McLeod R S, Lavery I C, Leatherman J R et al. Factors affecting quality of life with a conventional ileostomy. World J Surg. 1986;10(03):474–480. https://doi.org/10.1007/BF01655313 DOI: https://doi.org/10.1007/BF01655313
3. Shiomi A, Ito M, Saito N et al. Diverting stoma in rectal cancer surgery. A retrospective study of 329 patients from Japanese cancer centers. Int J Colorectal Dis. 2011;26(01):79–87. https://doi.org/10.1007/s00384-010-1036-0 DOI: https://doi.org/10.1007/s00384-010-1036-0
4.Williams N S, Nasmyth D G, Jones D, Smith A H. De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg. 1986;73(07):566–570. https://doi.org/10.1002/bjs.1800730717 DOI: https://doi.org/10.1002/bjs.1800730717
5. Mengual-Ballester M, García-Marín J A, Pellicer-Franco E et al. Protective ileostomy: complications and mortality associated with its closure. Rev Esp Enferm Dig. 2012;104(07):350–354. https://doi.org/10.4321/s1130-01082012000700003 DOI: https://doi.org/10.4321/S1130-01082012000700003
6. Correa Marinez A, Erestam S, Haglind E et al. Stoma-Const--the technical aspects of stoma construction: study protocol for a randomised controlled trial. Trials. 2014;15:254. https://doi.org/10.1186/1745-6215-15-254 DOI: https://doi.org/10.1186/1745-6215-15-254
7. Klink, C. D., et al. "Diversion Stoma After Colorectal Surgery: Loop Colostomy or Ileostomy?" International Journal of Colorectal Disease, vol. 26, no. 4, Apr. 2011, pp. 431–36. DOI: https://doi.org/10.1007/s00384-010-1123-2
8. Lazarov D, Semerdzhiev I, Nametkov B, Durmush Y, Petrov M, Dimitrov D, Hodzhadzhikov E, Tabakov M, Filipov A. Protective stoma in anterior resection of the Rectum –when,which type, and for how long? Scripta Scientifica Medica, 2025;57(suppl. 2):178-183. doi: 10.14748/jry3td22. https://press-muv.com/ssm/web/index.php/ssm/article/view/105
9. Wu SW, Ma CC, Yang Y. Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis. World J Gastroenterol. 2014 Dec 21;20(47):18031-7. https://doi.org/10.3748/wjg.v20.i47.18031 DOI: https://doi.org/10.3748/wjg.v20.i47.18031
10. Ahmad NZ, Abbas MH, Khan SU, Parvaiz A. A meta-analysis of the role of diverting ileostomy after rectal cancer surgery. Int J Colorectal Dis. 2021; 36(3): 445–55. DOI: https://doi.org/10.1007/s00384-020-03771-z
11. Yang YW, Huang SC, Cheng HH, et al. Protective loop ileostomy or colostomy? A risk evaluation of all common complications. Ann Coloproctol. 2024 Dec;40(6):580-7. https://doi.org/10.3393/ac.2022.00710.0101 DOI: https://doi.org/10.3393/ac.2022.00710.0101
12. Xu V, La K, Ma R, et al. Short-term outcomes of low anterior resection with and without ileostomy for low, mid and upper rectal cancers. Updates Surg. 2025 Jun;77(3):629-636. https://doi.org/10.1007/s13304-025-02088-2 DOI: https://doi.org/10.1007/s13304-025-02088-2
13. Floodeen, H., R. Lindgren, and P. Matthiessen. "When Are Defunctioning Stomas in Rectal Cancer Surgery Really Reversed? Results from a Population-Based Single Center Experience." Scandinavian Journal of Surgery, vol. 102, no. 4, 2013, pp. 246–50. DOI: https://doi.org/10.1177/1457496913489086
14. Tabakov M, Filipov A. Laparoscopic Total Mesorectal Excision After 450 Cases. Scr Sci Med. 2023;55(Suppl 2):37-41. https://doi.org/10.14748/ssm.v55i0.9307 DOI: https://doi.org/10.14748/ssm.v55i0.9307
15. Stenerцs OM. Protective ileostomy after low rectal resection: to do or not to do, advantages and disadvantages. Master’s Thesis. Faculty of Medicine, Department of Surgery; 2023
16. Zarkov K., Nickolov N., Petkov Chr., Assenov A. Results of radical anterior rectal resections. 17th World Congress of IASGO, September 5-8, 2007, Bucharest, Romania
17. Podda M, Coccolini F, Gerardi C, et al. Early versus delayed defunctioning ileostomy closure after low anterior resection for rectal cancer: a meta-analysis and trial sequential analysis of safety and functional outcomes. Int J Colorectal Dis. 2022 Apr;37(4):737-56. https://doi.org/10.1007/s00384-022-04106-w DOI: https://doi.org/10.1007/s00384-022-04106-w
18. Beirens K, Penninckx F; PROCARE. Defunctioning stoma and anastomotic leak rate after total mesorectal excision with coloanal anastomosis in the context of PROCARE. Acta Chir Belg. 2012 Jan;112(1):10-4. https://doi.org/10.1080/00015458.2012.11680789 DOI: https://doi.org/10.1080/00015458.2012.11680789
19. Ptok H, Marusch F, Meyer F, et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg. 2007 Dec;94(12):1548-54. https://doi.org/10.1002/bjs.5707 DOI: https://doi.org/10.1002/bjs.5707
20. Ulrich AB, Seiler C, Rahbari N, et al. Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum. 2009 Mar;52(3):412-8. https://doi.org/10.1007/DCR.0b013e318197e1b1 DOI: https://doi.org/10.1007/DCR.0b013e318197e1b1
21. Lipska MA, Bissett IP, Parry BR, et al. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg. 2006 Jul;76(7):579-85. https://doi.org/10.1111/j.1445-2197.2006.03780.x DOI: https://doi.org/10.1111/j.1445-2197.2006.03780.x
22. Rahbari NN, Weitz J, Hohenberger W. et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 2010; 147 (03) 339-351 DOI: https://doi.org/10.1016/j.surg.2009.10.012
23. Kulu Y, Ulrich A, Bruckner T. et al; International Study Group of Rectal Cancer. Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery 2013; 153 (06) 753-761 DOI: https://doi.org/10.1016/j.surg.2013.02.007
24. Frouws MA, Snijders HS, Malm SH, Liefers GJ, Van de Velde CJH, Neijenhuis PA, et al. Clinical relevance of a grading system for anastomotic leakage after low anterior resection: analysis from a national cohort database. Dis Colon Rectum. 2017; 60(7): 706–13. DOI: https://doi.org/10.1097/DCR.0000000000000800
25. Hatch KD; Gelder MS; Soong SJ; Baker VV; Shingleton HM. Pelvic exenteration with low rectal anastomosis: survival, complications, and prognostic factors. Gynecol Oncol. 1990; 38(3):462-7 DOI: https://doi.org/10.1016/0090-8258(90)90092-Y
26. Mengual-Ballester M, García-Marín J A, Pellicer-Franco E et al. Protective ileostomy: complications and mortality associated with its closure. Rev Esp Enferm Dig. 2012;104(07):350–354. https://doi.org/10.4321/s1130-01082012000700003 DOI: https://doi.org/10.4321/S1130-01082012000700003
27. Belghiti, J., et al. "Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis." Journal of Minimally Invasive Gynecology, vol. 21, no. 3, June 2014, pp. 472–79 DOI: https://doi.org/10.1016/j.jmig.2013.12.094
28. Thoker, M., et al. "Role of Diversion Ileostomy in Low Rectal Cancer: A Randomized Controlled Trial." International Journal of Surgery, vol. 12, no. 9, 16 July 2014, pp. 945–51 DOI: https://doi.org/10.1016/j.ijsu.2014.07.012
29. Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008; 248(1): 52–60 DOI: https://doi.org/10.1097/SLA.0b013e318176bf65
30. De Miguel Velasco, M., F. Jiménez Escovar, and A. Parajó Calvo. "[Current Status of the Prevention and Treatment of Stoma Complications. A Narrative Review]." Cirugía Española, vol. 92, no. 3, Mar. 2014, pp. 149–56 DOI: https://doi.org/10.1016/j.cireng.2013.09.021
31. Abudeeb H, Hammad A, Ugwu A, Darabnia J, Malcomson L, Maung M, et al. Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: a retrospective analysis of stoma database. Ann Med Surg. 2012; 2017(21): 114–7 DOI: https://doi.org/10.1016/j.amsu.2017.07.044
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Kostadin Zarkov, Christian Petkov, Vanina Kazalieva (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
