Comparison of trocar-site and conventional diverting ileostomy techniques in laparoscopic low anterior resection

INTRODUCTION: Protective loop ileostomy is commonly performed following laparoscopic low anterior resection for rectal cancer to reduce the clinical consequences of anastomotic leakage. Traditionally, the stoma is created through a separate abdominal incision; however, enlarging an existing trocar site may represent a less invasive alternative. This study aimed to compare the surgical and postoperative outcomes of ileostomy creation by enlarging a laparoscopic trocar site with those created through a conventional incision.
METHODS: This retrospective study included 92 patients who underwent laparoscopic low anterior resection with a protective loop ileostomy for rectal cancer between 2016 and 2024. Patients were divided into two equal groups according to the stoma creation technique. In Group T (n=46), the ileostomy was constructed by enlarging a 12-mm trocar site, whereas in Group C (n=46) a conventional abdominal incision was used. Operative time, postoperative complications (ileus, wound infection, and incisional hernia), length of hospital stay, and patient-reported aesthetic satisfaction were evaluated and compared between the groups.
RESULTS: Baseline demographic and clinical characteristics were comparable between the two groups. Operative time was significantly shorter in Group T than in Group C. Postoperative wound infection occurred less frequently in the trocarsite group, whereas the rates of ileus and incisional hernia were similar between the groups. Patients in Group T also reported significantly higher aesthetic satisfaction. No significant difference was observed in the length of hospital stay.
DISCUSSION AND CONCLUSION: Creating a protective loop ileostomy by enlarging a trocar site appears to be a safe and feasible alternative to the conventional incision technique. This approach may reduce operative time, decrease wound-related complications, and provide superior cosmetic outcomes in patients undergoing laparoscopic low anterior resection for rectal cancer.

Keywords: Laparoscopy, rectal cancer, ileostomy.