Comparison of Two Specimen-Extraction-Site Loop Ileostomy Construction Strategies After Laparoscopic Low Anterior Resection: A Retrospective Study.

BACKGROUND

Specimen-extraction-site (SES) loop ileostomy has been used to avoid an additional abdominal incision after laparoscopic low anterior resection. However, the optimal technique for constructing this type of ileostomy remains uncertain. This study aimed to compare two SES loop ileostomy construction strategies.

METHODS

We retrospectively analyzed 419 patients with rectal cancer who underwent laparoscopic low anterior resection with SES loop ileostomy between 2018 and 2021. Patients were categorized according to the ileostomy construction strategy: nonsuturing of the peritoneum-rectus sheath with routine support-rod placement (Group A, n = 256) or peritoneum-rectus sheath suturing without support-rod placement (Group B, n = 163). Baseline characteristics, operative outcomes, stoma-related complications, parastomal hernia, and reversal outcomes were compared.

RESULTS

Baseline characteristics were comparable between groups. Ileostomy construction was faster in Group A than in Group B (14.2 ± 5.3 vs. 22.6 ± 8.2 min, p < 0.001). Overall stoma-related complications and reversal outcomes were similar between groups. In the overall cohort, no significant differences were observed in overall, symptomatic, or asymptomatic CT-detected parastomal hernia. In subgroup analysis, Stage III patients in Group A had a higher rate of symptomatic parastomal hernia than those in Group B, whereas overall and asymptomatic CT-detected parastomal hernia did not differ significantly.

CONCLUSION

The two SES loop ileostomy construction strategies showed broadly comparable overall stoma-related and reversal outcomes. Among Stage III patients, however, the nonsuturing strategy with support-rod placement was associated with a higher rate of symptomatic parastomal hernia. Given the retrospective design, the subgroup nature of this finding, and the difference in support-rod use between groups, the results should be interpreted cautiously.