Abstract:

Objective To compare the safety of median specimen extraction incision and traditional new right lower abdominal incision for prophylactic ileostomy in radical resection of rectal cancer. Methods The data of 61 patients with rectal cancer who underwent laparoscopic anterior resection and prophylactic ileostomy in the first affiliated hospital of Nanchang University from April 2019 to February 2021 were collected and reviewed retrospectively. They were divided into two groups：the median incision group（IMI group）and the new right lower abdominal incision（INI group）. The two groups were compared in terms of baseline data，intraoperative and post⁃ operative conditions of ileostomy and ileostomy closure. Results There was no significant difference between the IMI group and the INI group in terms of baseline data，operation time，blood loss，postoperative pain score，first exhaust time，feeding time，catheter removal time，drainage tube removal time，postoperative hospital stay，total cost and postoperative pathological results. There was no significant difference either in the incidence of stoma⁃ related complications between them（26.7% vs. 29.0%，P = 0.698）. The non ⁃stoma ⁃ related complications in the IMI group was significantly lower than the INI group（6.7% vs. 29.0%，P = 0.023）. For the operation of ileostomy closure，the average interval from the first operation to ileostomy closure in the IMI group was significantly shorter than that in the IMI group［（110.0 ± 32.0）d vs.（159.4 ± 73.4）d，P < 0.001）］，the first exhaust time of the IMI group was significantly shorter than that of the INI group［（2.5 ± 0.5）d vs.（2.9 ± 0.7）d，P = 0.010］，and the first feeding time of the IMI group was significantly shorter as well［（2.7 ± 0.5）d vs.（3.0 ± 0.5）d，P = 0.04］. There was no significant difference in the incidence of incisional hernia between the two groups. Conclusion Both the new right lower abdominal incision and the median incision for prophylactic ileostomy are safe in radical resec⁃ tion of rectal cancer. Comparatively，the former approach is advantageous for its less damage to the abdominal wall as well as less abdominal scarring. It can be used as a new option for prophylactic ileostomy.

Key words:

median incision, ileostomy, rectal cancer, laparoscopic surgery