Introduction. Protective ileostomy is frequently used in laparoscopic rectal cancer surgery to reduce anastomotic leakage (AL), a severe complication. However, it also presents risks such as dehydration and the need for reversal surgery.
The objective of the study was to assess the clinical necessity of a diverting ileostomy in laparoscopic rectal cancer surgery by evaluating its impact on AL rates and associated postoperative outcomes, including complications and additional surgical interventions.
Material and methods. A systematic review was conducted using Cochrane, PubMed, EMBASE, and Web of Science databases. Studies examining laparoscopic rectal cancer surgery with or without protective ileostomy and reporting postoperative outcomes were included. Statistical analyses assessed the mean differences and risk ratios, with significance set at p < 0.05.
Results. A meta-analysis of eight studies involving 1,974 patients (847 with ileostomy) found a significantly lower AL rate in the ileostomy group (4.25%) compared to the non-ileostomy group (10.63%). No significant differences were found in hospital stays, and reoperation rates varied. Ileostomy-related complications, including dehydration and electrolyte imbalances, were common and required medical intervention. The high heterogeneity in hospital stays and reoperation rates suggest variability in institutional practices.
Conclusions. Protective ileostomy effectively reduces AL risk in high-risk patients but poses additional risks. Its use should be individualized based on patient-specific factors. Further research is needed to refine patient selection and explore alternative strategies.
Keywords: protective ileostomy, laparoscopic rectal cancer surgery, anastomotic leakage, postoperative complications, diverting ileostomy.
Full text sources https://doi.org/10.31688/ABMU.2025.60.1.14
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Address for correspondence:
Flaviu I. FAUR
2nd General Surgery Department, Timisoara Emergency County Hospital, Timisoara, Romania
Email: flaviu.faur@umft.ro; Phone: +40 741 577 091
