Do end colostomies (end colostomies) or loop colostomies (loop colostomies) have a higher risk of prolapse?

From the Guidelines

Loop colostomies have a higher risk of prolapse compared to end colostomies. This is primarily because loop colostomies involve bringing a loop of bowel to the abdominal surface and creating an opening, which leaves more mobile bowel that can protrude through the stoma. According to the study published in the Annals of Oncology 1, the technique of choice for colostomy is an end colostomy, carried out either by open surgery or laparoscopically, as loop colostomy is discouraged due to the high rates of parastomal hernias and prolapses.

The key factors that contribute to the increased risk of prolapse with loop colostomies include:

• They are often created with less tension on the bowel
• They typically have a larger fascial opening to accommodate both limbs of the loop
• They are frequently performed in emergency situations where the bowel may be edematous
• They are often temporary, so surgeons may be less meticulous with their construction compared to permanent end colostomies

Patients with loop colostomies should be educated about the signs of prolapse, which include a lengthening or enlargement of the stoma, and should seek medical attention if these occur. Proper stoma site marking by an enterostomal therapist before surgery and careful surgical technique can help minimize the risk of prolapse with either type of colostomy. The study 1 emphasizes the importance of considering the high likelihood that a pre-treatment colostomy will be permanent, and thus, patients should be advised accordingly.

From the Research

Comparison of End Colostomy and Loop Colostomy Complications

• The risk of prolapse is higher in loop colostomies compared to end colostomies, as shown in a study published in the Journal of Pediatric Surgery 2, which found that the incidence of prolapse was 17.8% in loop colostomies and 2.8% in divided colostomies.
• A systematic review and meta-analysis published in the Journal of Pediatric Surgery 3 also found that loop colostomies had a significantly higher prolapse rate compared to divided colostomies.
• Another study published in the European Journal of Trauma and Emergency Surgery 4 found that patients with end colostomies were more likely to require midline laparotomy, had greater intra-operative blood loss, and had more overall complications compared to patients with loop colostomies.
• However, a study published in Surgery, Gynecology & Obstetrics 5 found that the complication rates for closure of loop and end colostomies were identical, and that the mortality rates were not significantly different.

Prolapse Risk

• Loop colostomies are associated with a higher risk of prolapse, with a study published in the Journal of Pediatric Surgery 2 finding that the incidence of prolapse was 17.8% in loop colostomies.
• The use of a mesh strip technique has been shown to be a effective treatment for colostomy prolapse, with a study published in Clinics (Sao Paulo, Brazil) 6 finding that the technique was safe and effective in treating colostomy prolapse with no postoperative complications or recurrence.

Complications

• The overall complication rate for colostomy closure is significant, with a study published in the European Journal of Trauma and Emergency Surgery 4 finding that 45% of patients experienced at least one complication.
• The type of colostomy (loop or end) may influence the risk of complications, with some studies suggesting that loop colostomies may be associated with a higher risk of prolapse and other complications 2, 3.