Comparing Wafi ileostomy to Brooke ileostomy in stage 3 rectal cancer: a prospective cohort study.

Abstract

The aim of this study was to compare Wafi ileostomy to Brooke ileostomy in patients undergoing elective resection for stage 3 rectal cancer in terms of ileostomy creation and reversal-related complications. This was a prospective cohort study enrolling consecutive patients with stage 3 distal rectal cancer undergoing elective TME with Wafi or Brooke ileostomy at a median 8-week interval following neoadjuvant chemoradiation in two institutions. Wafi ileostomy was defined as the insertion of a soft polyvinylchloride spiral endotracheal tube into the afferent limb of the terminal ileum with a flexible rubber band passed behind the backwall of its efferent limb to occlude. Brooke ileostomy was defined as the exteriorization of the terminal ileum afferent limb through the abdominal wall (then everted and sutured to the skin) with the efferent limb acting as mucous fistula. Propensity score matching with a 1:1 ratio was employed to compare diagnosis-matched patients for age, gender, and American Society of Anesthesiologists score. During 5 years, 110 patients underwent TME with Wafi ileostomy, whereas 116 patients underwent TME with Brooke ileostomy. Propensity score matching left 99 Wafi and 99 Brooke comparable patients. Wafi ileostomy was reversed (tube removed at bedside) at median postoperative day (POD) 14 (same hospital stay) as compared to 150 days of ileostomy reversal (second surgery) in the Brooke ileostomy group (p < 0.001). Ileostomy-related overall complication rates were significantly lower in Wafi ileostomy patients (6% vs. 24%, p = 0.001). On multivariable logistic regression, dehydration was found to be associated with increased emergency room visits and readmissions in Brooke ileostomy patients (OR = 1.24 (1.03, 3.92); p = 0.044). Compared to Brooke, Wafi ileostomy with its reversal at bedside without need for a second surgery was associated with fewer complications.