BACKGROUND: Fecal diversion is commonly performed for various indications; however, the optimal choice of diversion remains debated in many cases, and morbidity may differ significantly between diverting loop ileostomies and loop colostomies. OBJECTIVE: To compare readmissions and stoma-related complications between patients with diverting loop ileostomy and colostomy. DESIGN: Retrospective cohort study. SETTINGS: Single academic tertiary medical center. PATIENTS: Adults aged ≥18 years who underwent temporary diverting loop ileostomy or colostomy between 2015 and 2025. MAIN OUTCOME MEASURES: Readmissions, stoma-related complications, stoma revision rates, and patient-reported pouching issues. RESULTS: A total of 515 patients were included (306 ileostomies, 209 colostomies). Patients with ileostomies had higher rates of readmissions due to stoma-related complications (23% vs 13%, p = 0.013). Readmissions due to dehydration were significantly higher among patients with ileostomies (60% vs 11%, p < 0.001). Administration of outpatient intravenous fluids did not prevent readmission, as 20% (n = 19) of patients who were readmitted had received outpatient intravenous fluids and 83% (n = 15) of readmitted patients on outpatient intravenous fluids were readmitted for dehydration. Patients with ileostomy had higher rate of pouching issues (68% vs 43%; p < 0.001). Patients with colostomy, however, had higher rates of prolapse (16% vs 4%; p < 0.001), and stoma revision (12% vs 4%; p < 0.001). On multivariable analysis, ileostomy was independently associated with higher odds of readmission (OR:3.15, 95% CI:1.76–5.65). LIMITATIONS: As a retrospective, single-institution design, this study may not capture readmissions or complications that occurred outside our health system. The patient population may limit generalizability. CONCLUSION: Patients with diverting ileostomy were more frequently readmitted compared to patients with diverting colostomy. Indications for readmission also differed between the 2 groups. Patients with ileostomies reported more pouching issues and developed more often dehydration. While patients with colostomies had higher prolapse rates, prolapse alone did not lead to higher revision rates. Surgeons should discuss these outcomes when reviewing potential diversion options with patients. See Video Abstract.
Arndt et al. (Thu,) studied this question.