Ileostomy or protective colostomy in low colorectal anastomoses

This narrative literature review analyses and compares ileostomy and protective colostomy in low colorectal anastomoses, with an emphasis on contemporary approaches to the prevention and management of postoperative complications. Articles published between 2020 and 2025 were included, selected from the Science Direct, Scielo, PubMed, and Google Scholar databases, covering randomised clinical trials, systematic reviews, cohorts, and case reports. Ileostomy, generally preferred because it presents a lower risk of prolapse and local mechanical complications, was associated with higher rates of dehydration, hydroelectrolytic disorders, and skin irritation. Colostomy, on the other hand, had a lower incidence of these metabolic complications but a higher propensity for fistulas, stenosis, and prolapse. Clinical trials highlighted preventive strategies, such as indocyanine green fluorescence angiography, negative pressure dressings, and minimally invasive transanal approaches, which aim to reduce anastomotic leaks and surgical site infections. Prospective and cohort studies have highlighted the importance of factors such as nutritional status, suture technique, stapler type, and predictive models for post-stoma closure complications. The evidence indicates that no one technique is absolutely superior to another; the decision must be individualised, considering clinical profile, risk of leakage, and intraoperative conditions. The study reinforces the need for standardisation of evidence-based practices and multidisciplinary follow-up to optimise surgical outcomes and patients' quality of life.