Loop colostomy offers comparable short-term surgical outcomes with fewer metabolic complications than loop ileostomy after laparoscopic low anterior resection post-total neoadjuvant therapy: developing-country perspective

Defunctioning stomas are standard in low anterior resection (LAR) posttotal neoadjuvant therapy (TNT) to mitigate anastomotic complications. While loop ileostomy is common, it poses significant metabolic risks. This study investigates whether loop colostomy may reduce renal and electrolyte complications, without compromising surgical or stoma reversal outcomes. We retrospectively analyzed 97 patients with rectal cancer treated at King Hussein Cancer Center (January 2020 to November 2024) who underwent TNT followed by LAR with a defunctioning stoma (ileostomy, n = 57; colostomy, n = 40). Primary outcomes were acute kidney injury (AKI) and hyponatremia. Secondary outcomes included stoma-related and closure-related complications. Data were compared using chi-squared, Mann–Whitney U -test, and Kaplan–Meier analysis. Baseline characteristics were comparable, except for higher baseline creatinine in ileostomy patients ( p = 0.002). Ileostomy was associated with more AKI (35.1% versus 2.5%, p < 0.001) and hyponatremia (57.8% versus 20.0%, p < 0.001) with greater stoma output ( p < 0.001). Skin excoriation was more frequent with ileostomy (24.5% versus 5.0%, p = 0.011), while colostomy had higher stoma prolapse (22.5% versus 1.7%, p < 0.001). Other postoperative outcomes were similar. However, blood loss during stoma reversal was greater with ileostomy ( p < 0.001). Kaplan–Meier analysis showed no difference in time to closure (median 84 versus 85 days, p = 0.491). In multivariate analysis, ileostomy remained associated with AKI and hyponatremia after adjustment for the included covariates. Loop colostomy may represent an alternative to loop ileostomy after LAR following TNT, with fewer metabolic complications and comparable surgical outcomes, despite a higher prolapse risk.