Selective temporary protective loop ileostomy in complex rectal resection for deep infiltrating endometriosis: a prospective matched cohort study on bowel function, quality of life, and postoperative complications

BACKGROUND: This study aimed to evaluate the impact of temporary protective loop ileostomy (PLI) on postoperative complications, bowel function, and quality of life (QoL) in women undergoing rectal surgery for deep infiltrating endometriosis (DIE) requiring concomitant vaginal and rectal repair. METHODS: In this prospective observational cohort study conducted at Baghdad Teaching Hospital, Medical City, and Kamal Al-Samarrai Hospital (April 2023-April 2024), 230 women underwent colorectal endometriosis surgery. From this population, 42 women with technically feasible colorectal anastomoses were selected; 21 who received a temporary protective loop ileostomy (PLI) were matched 1:1 by age and key risk factors to 21 women without PLI (WPLI). Postoperative outcomes, including the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC-BFI score) and QoL (EHP-5 score), were assessed using validated Arabic versions of psychometric instruments at baseline and one year postoperatively. Surgical complications were classified per Clavien-Dindo criteria. RESULTS: Both groups demonstrated significant improvement in pain symptoms, bowel function, and QoL at 12-month follow-up (p < 0.05). Observed differences in postoperative bowel function (MSKCC-BFI: 86.4 ± 4.3 vs. 88.2 ± 4.4; p > 0.05) and EHP-5 scores (28.1 ± 5.3 vs. 31.3 ± 4.3; p > 0.05) should be interpreted as exploratory trends given limited power. Postoperative complication rates (9.5% vs. 14.3%; p = 0.211) suggest a possible pattern. CONCLUSIONS: In women with DIE and technically feasible colorectal anastomoses, selective use of temporary protective loop ileostomy was not associated with significant detriment to bowel function or QoL in this small matched cohort and may be linked to lower rates of severe anastomotic complications. Given the limited sample size and observational design, these findings should be considered preliminary. Larger, adequately powered randomized trials with extended follow-up are warranted to confirm these observations.