Comparison between the outcome of tube ileostomy and loop ileostomy as a temporary diversion procedure: a randomized controlled trial
Keywords:
Tube ileostomy, Loop ileostomy, Diversion procedure, Stoma complications, Wound infectionAbstract
Background: This study aimed to compare the outcomes of tube ileostomy and loop ileostomy in pediatric patients undergoing temporary fecal diversion, focusing on stoma-related complications and wound infection.
Methods: A randomized controlled trial was conducted at the Department of Pediatric Surgery, University of Child Health Sciences, Lahore, from August 2021 to July 2022. A total of 68 patients were enrolled and randomized into two groups: Group A (tube ileostomy) and Group B (loop ileostomy) through balloting. After an interim analysis at 40 cases, further recruitment to Group A was halted due to a high rate of re-explorations attributed to tube failure. The remaining patients were assigned to Group B. Variables compared included operative time, hospital stay, time to ileostomy function, stoma-related complications, wound infection, and reoperation rates. Statistical analysis was performed using chi-square and independent t-tests via SPSS 20.0.
Results: Of 68 patients, 20 underwent tube ileostomy and 48 had loop ileostomy. Both groups were similar in age, gender distribution, and disease profile. Group A had slightly longer operative time and hospital stay, with no significant difference (p=0.823 and p=0.099, respectively). Time to ileostomy function was shorter in Group A (p=0.037). Re-exploration was more frequent in Group A (30%) compared to Group B (12.5%), though statistically insignificant (p=0.085). Stoma-related complications were significantly fewer in Group A (p=0.027). Wound infection rates were comparable between groups (p=0.909).
Conclusion: Although tube ileostomy demonstrated fewer stoma-related complications, the higher rate of re-explorations raises safety concerns. Based on current findings, tube ileostomy cannot be recommended as a routine diversion procedure in children. Larger multicenter trials using wider caliber tubes are recommended to evaluate its potential role in selected cases.
Keywords: Tube ileostomy, Loop ileostomy, Diversion procedure, Stoma complications, Wound infection
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