Double-Tube End Ileostomy: An Alternative to Classical Defunctioning Stoma in Rectal Surgery

Double-Tube End Ileostomy: An Alternative to Classical Defunctioning Stoma in Rectal Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Double-Tube End Ileostomy: An Alternative to Classical Defunctioning Stoma in Rectal Surgery Yihui Xia, Hongbo Lu, Longzhen Qiu, Yunsheng Ding, Shouhong Wan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5982369/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Dec, 2025 Read the published version in Techniques in Coloproctology → Version 1 posted 6 You are reading this latest preprint version Abstract Objective: This study compares the clinical benefits of double-tube end ileostomy versus traditional end ileostomy in patients undergoing low anterior resection for rectal cancer. Methods: A retrospective analysis was conducted on 65 patients who underwent laparoscopic radical rectal cancer surgery with preventive ileostomy between March 2022 and December 2024 at the First Affiliated Hospital of Anhui Medical University. Of these, 47 patients received traditional ileostomy, while 18 patients underwent double-tube ileostomy. The clinical characteristics and follow-up outcomes of the two groups were compared. Results: Both groups showed no significant differences in intraoperative blood loss, postoperative bowel function recovery, or complication rates ( p >0.05). However, the double-tube ileostomy group had superior outcomes: average stoma creation time was 25.39±2.85 minutes, postoperative hospital stays averaged 8.89±2.30 days, and total hospitalization costs were 57796.50±5306.30 RMB, all significantly lower than in the traditional ileostomy group ( p <0.01). Complications were fewer in the double-tube group, with only one case of type A anastomotic leakage (5.56%) and no long-term complications following successful tube removal. In contrast, the traditional group had four cases of leakage (8.51%), and 16 patients experienced long-term complications, with only 40 (85.11%) achieving successful stoma closures. Furthermore, traditional group patients reported higher SCL-90 scores for somatization and sleep and eating problems ( p <0.05), indicating significant differences between the groups. Conclusion: Double-tube end ileostomy offers a safe and effective alternative to traditional methods, with shorter operative times, fewer secondary surgeries, and reduced physiological, psychological, and financial burdens on patients. anastomotic leak ileostomy low rectal cancer stoma reversal surgery Figures Figure 1 Figure 2 Figure 3 Introduction In recent years, advancements in surgical techniques and treatment strategies have significantly improved the prognosis of patients with low- and middle-rectal cancer (LRC) [ 1 – 3 ]. Despite these advancements, sphincter-preserving surgery for LRC still carries the risk of anastomotic leakage, primarily due to the lower position of the anastomosis and the involvement of multiple blood vessels [ 4 – 6 ]. Anastomotic leakage can result in severe complications, including wound infections, intra-abdominal abscesses, diffuse peritonitis, and sepsis [ 7 , 8 ], which may negatively impact patient outcomes [ 9 ]. To mitigate the risk of anastomotic leakage and improve prognosis, diversion ileostomy is commonly performed as a preventive measure [ 10 – 13 ]. However, patients who undergo this procedure must typically maintain the stoma for 3 to 6 months, during which they may experience complications such as peristomal dermatitis, parastomal hernia, and electrolyte imbalances [ 14 , 15 ]. These issues can significantly affect the patient's quality of life and increase their psychological burden [ 16 – 18 ]. Moreover, patients face the risks and costs associated with secondary stoma reversal surgery. Some patients are unable to undergo stoma reversal due to conditions such as rectal anastomotic stenosis, anastomotic leakage, or tumor recurrence, potentially resulting in a permanent stoma [ 19 , 20 ]. To address these challenges, this study introduces the double-tube end ileostomy (DTEI), also known as the Zou-style stoma, as an alternative technique. This study included 18 patients who underwent DTEI, and their clinical outcomes were compared with those of patients who underwent conventional end ileostomy. The primary aim of this study was to assess the safety and efficacy of DTEI in reducing postoperative complications following total mesorectal excision (TME). Additionally, the study aimed to explore whether DTEI could serve as a viable alternative to traditional ileostomy. Materials and methods Study Design This retrospective cohort study consecutively enrolled 65 patients who underwent radical rectal cancer surgery (Dixon) with prophylactic ileostomy at the First Affiliated Hospital of Anhui Medical University between March 2022 and December 2024. Patients were divided into two groups based on the type of ileostomy: 47 patients who underwent conventional ileostomy (CI group) and 18 patients who underwent double-tube end ileostomy (DTEI group). All patients were adjusted to a liquid diet 24 hours before surgery and underwent mechanical bowel preparation. The ileostomy procedures were performed immediately after the completion of radical rectal cancer surgery. The study was approved by the hospital's Medical Ethics Committee (approval number: PJ2023-13-34). Inclusion and Exclusion Criteria Inclusion Criteria: (1) Preoperative diagnosis of primary rectal cancer confirmed by imaging and pathological biopsy;(2) Preoperative pelvic MRI and contrast-enhanced CT showing no tumor invasion at the circumferential resection margin;(3) Tumor located ≤ 10 cm from the anal verge;(4) Preoperative assessment meeting criteria for sphincter-preserving surgery;(5) Underwent laparoscopic rectal cancer radical surgery with prophylactic ileostomy within the specified timeframe;(6) Completion of at least 6 months of follow-up with complete clinical data. Exclusion Criteria:(1) Tumor invasion into adjacent organs or distant metastasis; (2) Preoperative radiotherapy;(3) Severe systemic diseases (cardiovascular, neurological, hepatic, renal) contraindicating surgery;(4) Coexisting inflammatory bowel disease or familial adenomatous polyposis. Surgical Methods Low Anterior Resection for Rectal Cancer The surgical procedure adhered to the principles of total mesorectal excision and was conducted using the standard five-port laparoscopic approach for rectal cancer. During the procedure, the inferior mesenteric artery was ligated at a high level and divided at its root. A double-stapling technique with a stapler was employed to perform the colonic-rectal end-to-end anastomosis above the dentate line. Additionally, two to three abdominal drainage tubes were routinely placed near the anastomotic site. Double-Tube Ileostomy (Supplementary video) A 1.2–1.5 cm incision was made 3 cm to the right of the midline and 3 cm below the umbilicus (Fig. 1 a). The cecum was laparoscopically mobilized, and the terminal ileum was exteriorized through the midline incision. A 1.0 cm incision was made on the mesenteric edge of the ileum, 15 cm from the cecum (Fig. 2 a). A 12 Fr disposable sterile latex urinary catheter (Shida Industrial Co., Ltd., Zhanjiang, Guangdong Province, Model: Dual-lumen Balloon Standard Edition) was used as the distal tube, and a 7.0 tracheal tube (Kohai Medical Equipment International Trade Co., Ltd., Model: 9570E) served as the proximal tube. After confirming balloon integrity, the distal tube was inserted into the cecum via the ileocecal valve (Fig. 2 b), and the balloon was inflated by instilling water (Fig. 2 d). The proximal tube was inserted into the proximal ileum, with the balloon inflated for stability (Figs. 2 c, 2 e). Both tubes were anchored using a 4 − 0 absorbable purse-string suture (Fig. 2 f), externalized through the right lower abdominal incision, and secured by suturing the ileal wall and peritoneum (Fig. 2 g). A 10 − 0 silk suture was placed around the peritoneum for closure after tube removal (Fig. 1 c), and the tubes were fixed to the abdominal skin (Fig. 2 h). Conventional Ileostomy A 15–20 cm portion of the ileum was exteriorized through a right lower abdominal incision. A longitudinal incision was made for stoma creation, and the distal ileum was sutured closed with a standard stoma bag applied. Postoperative Care In the DTEI group, the proximal tube was connected to a thoracic drainage bottle, and the distal tube to a drainage bag. After intestinal peristalsis resumed, a low-residue diet was followed to maintain proximal tube patency. The daily drainage volume was monitored, and if signs of proximal tube obstruction occurred, immediate flushing was performed. Within 48 hours postoperatively, 5% glucose saline (250 mL) combined with gentamicin (160,000 units) was infused and flushed through the distal tube twice daily to irrigate and flush the colon. If no anastomotic leakage or infection signs appeared within 1–2 weeks post-surgery, a colon iodinated contrast study was performed via the distal tube (Fig. 3 d) to assess patency. After satisfactory results, the abdominal drainage tube was removed, and the dual-tube balloon water was aspirated bedside. Both tubes were removed (Figs. 1 c, 3 b), and the previously embedded 10# silk suture was tightened. The patient was discharged 1–2 days after tube removal if no abnormalities were observed. In the CI group, after intestinal peristalsis resumed, enteral nutrition was gradually introduced. Regular pouch changes and stoma care were performed. Once the abdominal drainage tube was removed without complications, the patient was discharged. Regular follow-up visits, including rectal exams and imaging studies, were scheduled 3–6 months later to monitor tumor recurrence or metastasis. Stoma reversal surgery was performed when appropriate. Follow-up Patients were followed up through outpatient visits and telephone calls over a 6-month period, with assessments scheduled at the 1st and 2nd weeks, 1st month, 3rd month, and 6th month post-discharge. The data collected included anastomotic healing, complications, tumor recurrence or metastasis, and survival status. During the third follow-up, psychological status was evaluated using the Symptom Checklist-90 (SCL-90). The follow-up period concluded in December 2024. Observation Indicators Intraoperative Factors: Surgery duration, intraoperative blood loss. Postoperative Factors: Time to bowel function recovery, 24-hour abdominal drainage volume, postoperative complications (e.g., anastomotic leakage, wound infection), total length of hospital stay, and total hospitalization costs. Follow-up Factors: Stoma reversal (or tube removal), stoma-related complications, anastomotic healing, psychological status, tumor metastasis, and survival rate. Statistical Methods Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Quantitative variables were reported as mean ± standard deviation and compared using the t-test when normality and homogeneity of variance were confirmed; otherwise, the Mann-Whitney U test was applied. Qualitative variables were summarized as counts and percentages and analyzed using the χ² test or Fisher’s exact test where applicable. A two-sided p -value of 0.05), as shown in Table 1 . Intraoperative Conditions Both groups of patients successfully underwent surgery with no mortality. No statistically significant differences were observed in operation time and intraoperative blood loss between the two groups ( P > 0.05). The mean time for stoma creation in the double-tube stoma group (25.39 ± 2.85 minutes) was significantly shorter than in the traditional stoma group (28.63 ± 4.23 minutes), with the difference being statistically significant ( P < 0.05), as illustrated in Table 2 . Table 1 Characteristics of the patients in the two groups Characteristics CI group (n = 47) DTEI group (n = 18) p -values Gender 0.673 Male 26 11 Female 21 7 Age (years) 59.23 ± 12.58 64.06 ± 9.03 0.094 Body-mass index (kg/m 2 ) 23.52 ± 3.92 22.81 ± 1.98 0.339 ASA score 0.722 I/II/III/IV 1/30/16/0 0/13/5/0 Smoking,Yes/No 6/41 5/13 0.149 Drinking,Yes/No 9/38 2/16 0.713 b Diabetes,Yes/No 8/39 2/16 0.713 b Prior abdominal surgery,Yes/No 11/36 6/12 0.415 Preoperative plasma albumin (g/L) 41.89 ± 4.66 40.64 ± 3.11 0.221 Tumour height from anal verge(cm) 5.41 ± 1.58 5.61 ± 1.29 0.637 Size of tumor (mm) 37.70 ± 15.25 39.22 ± 16.88 0.728 Tumour stage 0.680 I/II/III/IV 9/18/20/0 2/8/8/0 Tumor differentiation 0.435 Well/moderate/poor 0/37/10 1/13/4 a ASA American Society of Anesthesiologists b Fisher exact test Postoperative Conditions No statistically significant differences were observed in the time to recovery of bowel function between the two groups ( P > 0.05). In the traditional stoma group, 15 patients (31.9%) experienced postoperative complications, including 4 cases of anastomotic leakage (8.5%). In the double-tube stoma group, 3 patients (16.6%) experienced complications, with 1 case of anastomotic leakage (5.6%). No statistically significant differences were observed in the overall incidence of complications during hospitalization between the two groups ( P > 0.05). However, the total hospitalization duration and costs in the double-tube stoma group were significantly shorter and lower, respectively, than those in the traditional stoma group, with the differences being statistically significant ( P < 0.05), as shown in Table 2 . Table 2 Operative and postoperative results of the two groups Variables CI group (n = 47) DTEI group (n = 18) p -values Operative time (min) LAR b 191.06 ± 40.50 192.17 ± 21.04 0.887 Terminal ileostomy 28.63 ± 4.23 25.39 ± 2.85 0.004 * Blood loss (ml) 72.34 ± 50.87 92.78 ± 58.39 0.169 Postoperative abdominal drainage(ml) 90.21 ± 18.56 86.39 ± 15.12 0.439 Intestinal function recovery time(days) 2.23 ± 0.76 2.33 ± 0.59 0.619 Postoperative complications 0.549 a Anastomotic leakage 4 1 1.000 a Anastomotic bleeding 0 0 - Incisional infection 5 1 1.000 a Bowel obstruction 2 1 1.000 a Stoma infection 3 1 1.000 a Stoma bleeding 1 0 1.000 a Respiratory complications 6 2 1.000 a Urinary tract infection 3 0 0.555 a First postoperative hospital stay(days) 9.5 ± 2.4 8.89 ± 2.30 0.346 Second postoperative hospital stay c (days) 9.0 ± 4.4 - - Total postoperative hospital stay(days) 18.47 ± 4.83 8.89 ± 2.30 0.000 * First hospitalisation costs(rmb) 54834.66 ± 9162.40 57796.50 ± 5306.30 0.112 Second hospitalisation costs(rmb) 21247.66 ± 3649.60 - - Total hospitalisation costs(rmb) 76082.32 ± 10585.02 57796.50 ± 5306.30 0.000 * a Fisher exact test b Low Anterior Resection c Stoma retrieval surgery * Statistically significant Follow-up Conditions All 65 patients were followed up after discharge, with no reported deaths. In the traditional ileostomy group, 40 patients (85.1%) successfully underwent stoma reversal surgery. Seven patients required permanent stomas due to anastomotic stricture (5 cases), tumor recurrence (1 case), and personal reasons (1 case). The average time for stoma reversal after total rectal cancer resection was (161.5 ± 23.0) days, with an average surgical cost of (21,247.66 ± 3,649.60) RMB. The average hospital stay after stoma reversal was (9.0 ± 4.4) days. After stoma reversal, 7 patients (17.5%) developed complications, including 3 cases of intestinal obstruction, 2 cases of wound infection, 1 case of pulmonary infection, and 1 case of urinary retention. In the double-tube ileostomy group, all 18 patients successfully had their dual tubes removed, with an average tube removal time of (16.11 ± 2.14) days after total rectal cancer resection. No patients required a second surgery for a permanent stoma, and all stomas healed successfully after tube removal. One patient developed a stoma infection after tube removal, which resolved after symptomatic treatment. No patients experienced delayed stoma healing. During follow-up, the traditional stoma group experienced 6 cases of peristomal dermatitis, 1 case of stoma stenosis, 2 cases of stoma prolapse, 1 case of stoma retraction, and 2 cases of parastomal hernia. No long-term complications were observed in the double-tube stoma group. The difference in the incidence of long-term complications between the two groups was statistically significant ( P < 0.05), as shown in Table 3 . Table 3 Follow-up results of patients in two groups Variables CI group (n = 47) DTEI group (n = 18) p -values Long-term complications 16 0 0.004 * Peristomal dermatitis 6 0 0.175 a Stoma stenosis 1 0 1.000 a Stoma prolapse 2 0 1.000 a Stoma retraction 1 0 1.000 a Parastomal hernia 2 0 1.000 a Anastomotic stricture 5 0 0.311 a Tumour recurrence and metastasis 1 0 1.000 a Mortality 0 0 - a Fisher exact test * Statistically significant Psychological Assessment Results The results of the SCL-90 psychological assessment revealed that the traditional stoma group had a mean total score of 145.60 ± 16.89 and 36.11 ± 18.16 positive items, whereas the double-tube stoma group had a total score of 135.93 ± 13.64 and 26.47 ± 18.00 positive items. Comparative analysis indicated that the traditional stoma group had significantly higher total scores, as well as higher scores in the somatization factor and the sleep and eating problems factor, compared to the double-tube stoma group, with the differences being statistically significant ( P 0.05), as shown in Table 4 . Table 4 Comparison of SCL-90 scores between the two patient groups Factors CI group (n = 47) DTEI group (n = 18) p -values Somatization 1.78 ± 0.47 1.46 ± 0.41 0.013 * Obsessive-compulsive symptoms 1.64 ± 0.42 1.59 ± 0.44 0.685 Interpersonal sensitivity 1.63 ± 0.48 1.44 ± 0.30 0.063 Depression 1.80 ± 0.58 1.75 ± 0.49 0.743 Anxiety 1.62 ± 0.45 1.60 ± 0.39 0.847 Hostility 1.52 ± 0.46 1.52 ± 0.45 0.998 Fear 1.57 ± 0.48 1.49 ± 0.48 0.563 Paranoid ideation 1.35 ± 0.34 1.36 ± 0.39 0.895 Psychoticism 1.41 ± 0.41 1.37 ± 0.31 0.681 Sleep and eating problems 1.62 ± 0.51 1.33 ± 0.28 0.005 * Total score 145.60 ± 16.89 134.56 ± 13.14 0.015 * Positive symptoms total 36.11 ± 18.16 27.00 ± 16.61 0.090 * Statistically significant Discussion The use of temporary stomas after low- and mid-rectal cancer surgery to prevent anastomotic leakage remains debated [ 16 , 21 ]. The majority of scholars consider low- and mid-rectal cancers as independent risk factors for anastomotic leakage [ 9 , 10 , 22 , 23 ], thereby supporting the necessity of prophylactic stoma creation [ 24 ]. Although there is no consensus on its ability to reduce the incidence of anastomotic leakage, fecal diversion through the stoma can alleviate the severity of pelvic and abdominal infections following leakage and reduce mortality rates [ 11 ], thereby minimizing the need for surgical intervention in symptomatic anastomotic leaks (B and C types) [ 25 ]. Opponents contend that stoma creation does not reduce the incidence of anastomotic leakage, and that its adverse effects may outweigh its potential benefits [ 26 , 27 ]. To address this issue, several researchers [ 28 , 29 ] have sought to improve traditional stoma techniques by employing drainage tubes to replace intestinal diversion. However, a single balloon provides limited blockage of intestinal contents, and due to intestinal peristalsis, some small intestinal fluids may leak through the gap between the balloon and the intestinal wall, potentially contaminating the rectal anastomosis. In contrast, the DTEI fully utilizes the physiological and structural characteristics of the ileocecal valve, preventing the rapid influx of small intestinal contents into the colon. Additionally, it combines adjustable double balloons from endotracheal tubes and urinary catheters, achieving complete diversion of intestinal contents. This method entirely diverts intestinal fluid, effectively preventing digestive fluids and feces from contaminating and irritating the anastomosis, thereby reducing the pressure on the anastomotic site. Among 18 patients undergoing the new technique, the incidence of anastomotic leakage was lower than the reported average of 6.8–19.0% [ 30 – 32 ], likely due to complete intestinal fluid diversion and improved postoperative management. Additionally, as reported in the literature, the average time for the occurrence of anastomotic leakage is 7 days postoperatively [ 9 , 30 ]. In our study, we proactively conducted precise assessments of anastomotic healing within a postoperative window of 1 to 2 weeks, utilizing contrast agents or methylene blue injected through the distal tube. These assessments guided decisions on stoma tube removal.In the DTEI group, a 76-year-old male patient with diabetes developed an anastomotic leak on day 7 postoperatively, which was confirmed as a subclinical leak (Type A leak) through contrast-enhanced imaging. After conservative treatment, including continuous irrigation through the distal tube, antibiotic therapy, adequate drainage, and nutritional support, the patient successfully recovered and was discharged.In the hypothetical case of a Type B anastomotic leak, we propose that extending the tube indwelling time with the DTEI technique can provide the same protective effect on the anastomosis as traditional fistula surgeries. Additionally, a combination of fasting, antibiotic therapy, distal bowel irrigation, and other conservative measures can facilitate anastomotic healing and prevent the need for a secondary stoma. The catheter indwelling time can be adjusted based on infection control, with tube removal occurring once the lesion has stabilized, ensuring proactive and safe postoperative management.Among the 12 patients treated with the new technique in the early phase, one patient developed a direct intestinal fistula in the right lower abdomen after stoma removal, but successful healing occurred after dressing changes. Subsequently, in 6 patients, we implemented further optimization: placing purse-string sutures around the stoma margin during surgery and tightening them after tube removal, which effectively controlled intestinal fluid leakage and significantly shortened the healing time of the stoma. During follow-up, 16 patients in the traditional stoma group experienced long-term complications related to the stoma. Furthermore, 7 patients were unable to undergo successful stoma reversal due to anastomotic stenosis or tumor recurrence, ultimately requiring a permanent stoma. In contrast, the new technique effectively prevented complications such as stoma stenosis, prolapse, and retraction by avoiding external placement of the intestinal tube [ 14 , 33 , 34 ]. More importantly, this technique allows for bedside stoma tube removal, avoiding the risks associated with secondary reversal surgery. It also significantly reduced the treatment costs by approximately 21,247.66 RMB per patient and alleviated the economic burden. All 18 patients treated with the new technique successfully had their tubes removed, and their stomas closed naturally, avoiding secondary reversal surgery and improving the patients’ quality of life. Psychological assessments indicated greater distress in the traditional stoma group regarding mental health, somatization, and issues like sleep and diet. This difference may be attributed to the long-term stoma condition, which not only alters the patient's normal elimination pathways and body image [ 17 ], but also increases daily care demands [ 35 ] and induces a sense of social isolation [ 36 ], further exacerbating psychological stress. In addition, patients often experienced sleep disturbances due to concerns about fecal leakage, stoma bag dislodgement, and displacement, making it difficult to maintain high-quality sleep, leading to physical discomfort and other symptoms [ 37 ]. There were no significant differences between the traditional stoma and double-tube ileostomy groups in intraoperative blood loss, recovery time, or complication incidence, suggesting comparable outcomes between Zou’s and traditional loop ileostomy. However, Zou’s ileostomy is technically simpler and avoids the cumbersome steps of multiple suturing of the intestinal tube to the abdominal wall required in traditional surgery, reducing the average operation time to (25.39 ± 2.85) minutes. Additionally, the new technique shows significant advantages in promoting nutritional recovery. Traditional stoma reversal is often influenced by postoperative adjuvant therapies such as radiotherapy and chemotherapy [ 38 ], and typically requires a waiting period of 3 to 6 months [ 19 , 39 , 40 ], which disrupts colonic absorption function for a prolonged period. In contrast, the new technique allows for early restoration of water reabsorption in the colon to maintain fluid balance, regulate electrolytes like sodium and potassium to prevent metabolic disturbances, absorb short-chain fatty acids to provide energy for intestinal epithelial cells and maintain mucosal barrier integrity [ 41 ], and facilitate the absorption of vitamin K and B vitamins to improve the body’s nutritional status. Furthermore, by restoring the normal physiological function of the distal colon early, this technique prevents fecal incontinence or defecation difficulties that are common in traditional methods due to prolonged disuse of the anal sphincter, reducing the incidence of postoperative defecation disorders [ 42 ]. However, the currently used stoma tubes do not perfectly match the anatomical structure of the distal ileum and cecum. The proximal tube is relatively rigid, causing discomfort at the stoma site and posing a risk of tube obstruction. To address this, the team, with technical support from Hefei University of Technology and the University of Science and Technology of China, plans to further develop an intelligent warning stoma tube product for clinical application. Additionally, given the small sample size in this study, potential selection bias exists, and further multi-center studies with larger sample sizes are required to validate these conclusions. Conclusion In summary, Zou’s ileostomy technique is a promising alternative to traditional temporary ileostomy methods. It is simple to perform and effectively prevents complications such as anastomotic leakage, while avoiding secondary reversal surgery and long-term complications. This approach can significantly shorten hospitalization time, reduce both the physiological and psychological suffering of patients, and alleviate their financial burde. Declarations Authorship contribution Conceptualization: Bingbing Zou,Yihui Xia； Methodology: Bingbing Zou,Hongbo Lu,Longzhen Qiu； Formal analysis and investigation: Yihui Xia,Yingguang Fan,Yunsheng Ding,Shouhong Wan； Writing - original draft preparation: Yihui Xia； Writing - review and editing: Bingbing Zou； Funding acquisition: Bingbing Zou； Supervision: Bingbing Zou, Hongbo Lu Funding Financial support for this study was provided by the Health Research Program of Anhui (Grant No. AHWJ2024Aa40001) and the University Synergy Innovation Program of Anhui Province (Grant No. GXXT-2022-056). Data availability Data is available upon request to the corresponding author. Conflict of interest Authors have no conflict of interest. Ethics approval This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Anhui Medical University (PJ 2023-13-34). Consent for publication All authors approve the submission. 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Langenbecks Arch Surg 400:145–152. https://doi.org/10.1007/s00423-015-1275-1 Rahbari NN, Weitz J, Hohenberger W, et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the international study group of rectal cancer. Surgery 147:339–351. https://doi.org/10.1016/j.surg.2009.10.012 Ihnát P, Guňková P, Peteja M, et al (2016) Diverting ileostomy in laparoscopic rectal cancer surgery: High price of protection. Surg Endosc 30:4809–4816. https://doi.org/10.1007/s00464-016-4811-3 Snijders HS, Van Leersum NJ, Henneman D, et al (2015) Optimal Treatment Strategy in Rectal Cancer Surgery: Should We Be Cowboys or Chickens? Ann Surg Oncol 22:3582–3589. https://doi.org/10.1245/s10434-015-4385-7 Wang D, Huang Y, Wang W, et al (2018) Application value of the modified terminal cannula ileostomy in laparoscopic anus-preserving operation of low rectal cancer. Chin J Dig Surg 17:. https://doi.org/10.3760/cma.j.issn.173-9752.2018.02.013 Liu L, Huang Q, Wang J, et al (2016) Protection of low rectal anastomosis with a new tube ileostomy using a biofragmentable anastomosis ring: A retrospective study. Medicine (Baltimore) 95:e5345. https://doi.org/10.1097/MD.0000000000005345 Zhao S, Zhang L, Gao F, et al (2021) Transanal drainage tube use for preventing anastomotic leakage after laparoscopic low anterior resection in patients with rectal cancer: A randomized clinical trial. JAMA Surg 156:1151–1158. https://doi.org/10.1001/jamasurg.2021.4568 Degiuli M, Elmore U, De Luca R, et al (2022) Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study): A nationwide retrospective study of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group. Colorectal Dis Off J Assoc Coloproctology G B Irel 24:264–276. https://doi.org/10.1111/codi.15997 Wu Y, Zheng H, Guo T, et al (2017) Temporary diverting stoma improves recovery of anastomotic leakage after anterior resection for rectal cancer. Sci Rep 7:15930. https://doi.org/10.1038/s41598-017-16311-7 Mathew AP, M S, K C, et al (2022) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Indian J Surg Oncol 13:468–473. https://doi.org/10.1007/s13193-022-01501-1 Thalheimer A, Bueter M, Kortuem M, et al (2006) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum 49:1011–1017. https://doi.org/10.1007/s10350-006-0541-2 Rafiei H, Rashvand F, Malmir S (2020) Quality of life of family caregivers of patients with a stoma: A cross-sectional study from iran. Br J Nurs Mark Allen Publ 29:S27–S30. https://doi.org/10.12968/bjon.2020.29.22.S27 Li G, He X, Qin R, et al (2024) Linking stigma to social isolation among colorectal cancer survivors with permanent stomas: The chain mediating roles of stoma acceptance and valuable actions. J Cancer Surviv Res Pract. https://doi.org/10.1007/s11764-024-01614-2 Alwi F, Setiawan, Asrizal (2018) Quality of life of persons with permanent colostomy: A phenomenological study. J Coloproctology 38:295–301. https://doi.org/10.1016/j.jcol.2018.06.001 Herrle F, Sandra-Petrescu F, Weiss C, et al (2016) Quality of life and timing of stoma closure in patients with rectal cancer undergoing low anterior resection with diverting stoma: A multicenter longitudinal observational study. Dis Colon Rectum 59:281–290. https://doi.org/10.1097/DCR.0000000000000545 Keane C, Park J, Öberg S, et al (2019) Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg 106:645–652. https://doi.org/10.1002/bjs.11092 David GG, Slavin JP, Willmott S, et al (2010) Loop ileostomy following anterior resection: Is it really temporary? Colorectal Dis Off J Assoc Coloproctology G B Irel 12:428–432. https://doi.org/10.1111/j.1463-1318.2009.01815.x Seethaler B, Nguyen NK, Basrai M, et al (2022) Short-chain fatty acids are key mediators of the favorable effects of the mediterranean diet on intestinal barrier integrity: Data from the randomized controlled LIBRE trial. Am J Clin Nutr 116:928–942. https://doi.org/10.1093/ajcn/nqac175 Vogel I, Reeves N, Tanis PJ, et al (2021) Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: A systematic review and meta-analysis. Tech Coloproctology 25:751–760. https://doi.org/10.1007/s10151-021-02436-5 Additional Declarations No competing interests reported. Supplementary Files Surgicalvideo.mp4 DefinitionsCriteriaandNutritionPlan.docx Cite Share Download PDF Status: Published Journal Publication published 27 Dec, 2025 Read the published version in Techniques in Coloproctology → Version 1 posted Editorial decision: Revision requested 16 Jul, 2025 Reviews received at journal 15 Jul, 2025 Reviewers agreed at journal 05 May, 2025 Reviewers invited by journal 28 Apr, 2025 Submission checks completed at journal 16 Apr, 2025 First submitted to journal 15 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5982369","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449257203,"identity":"b5969f09-0eb8-481b-bf0b-7336362101ea","order_by":0,"name":"Yihui Xia","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yihui","middleName":"","lastName":"Xia","suffix":""},{"id":449257205,"identity":"ef954979-f6ba-4a76-a1da-1869509ad005","order_by":1,"name":"Hongbo Lu","email":"","orcid":"","institution":"Hefei University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Hongbo","middleName":"","lastName":"Lu","suffix":""},{"id":449257207,"identity":"63d24799-e496-4b05-a7ad-e83c1c3f1875","order_by":2,"name":"Longzhen Qiu","email":"","orcid":"","institution":"Hefei University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Longzhen","middleName":"","lastName":"Qiu","suffix":""},{"id":449257209,"identity":"525c262e-d584-42a0-860f-651a46139e55","order_by":3,"name":"Yunsheng Ding","email":"","orcid":"","institution":"Hefei University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Yunsheng","middleName":"","lastName":"Ding","suffix":""},{"id":449257211,"identity":"014da7bd-0b15-4a80-8558-9dbedfcbfd0c","order_by":4,"name":"Shouhong Wan","email":"","orcid":"","institution":"Hefei Comprehensive National Science Center","correspondingAuthor":false,"prefix":"","firstName":"Shouhong","middleName":"","lastName":"Wan","suffix":""},{"id":449257213,"identity":"5a9933c9-ccc2-400d-8a1c-4ba9f6a7fc3a","order_by":5,"name":"Yingguang Fan","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yingguang","middleName":"","lastName":"Fan","suffix":""},{"id":449257215,"identity":"d438e78e-f013-4c7b-9f56-aefb44347be1","order_by":6,"name":"Bingbing Zou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYHACNoYEBoYENgYGxgeMDWARA6K1MBsQrwUIEkAMCaK0yLf3mD14uKM2j0+6/VrFzx3bEhvYm7dJMNTcwamFseeMuUHimePFbDJnym72nrmd2MBzrEyC4dgznFqYJXLMJBLbjiW2SeSk3eBtA2oBiTA2HMbtEWQthX9BWuTf4NfCA9FSA9SSfowZYgsPfi0SPMfKDRLbDhQDrWOWlm27bdzGk1ZskXAMtxb59uZtD3+21eXJz0h/+PFt223ZfvbDG298qMGtBQpACngg0QGPJgKgDojZHxBWNwpGwSgYBSMSAADe41ckej4kbwAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Bingbing","middleName":"","lastName":"Zou","suffix":""}],"badges":[],"createdAt":"2025-02-07 15:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5982369/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5982369/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10151-025-03267-4","type":"published","date":"2025-12-27T15:58:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82068892,"identity":"5f988e81-d07a-4dcc-87a3-83ed543e4288","added_by":"auto","created_at":"2025-05-06 13:00:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":452817,"visible":true,"origin":"","legend":"\u003cp\u003eStoma localization and surgical procedure diagrams. \u003cstrong\u003e1a\u003c/strong\u003e: Schematic representation of stoma localization; A: Designated stoma site; B: Midline abdominal incision \u003cstrong\u003e1b\u003c/strong\u003e: Schematic illustration of the DTEI procedure \u003cstrong\u003e1c:\u003c/strong\u003e Cross-sectional view of DTEI technique; left arrow: Dermal anchoring suture; right arrow: Peritoneal buried suture \u003cstrong\u003e1d\u003c/strong\u003e: Anterior view of DTEI configuration\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5982369/v1/c2160b05c0d2dc7bdbe53d9c.png"},{"id":82067324,"identity":"25892703-52ca-4df7-8581-0c666f7dd750","added_by":"auto","created_at":"2025-05-06 12:44:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":771759,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical steps of the DTEI procedure.\u003cstrong\u003e2a\u003c/strong\u003e: A 1 cm longitudinal incision is made on the ileum, approximately 15 cm proximal to the ileocecal junction (right arrow), and purse-string sutures are placed around the incision (left arrow). \u003cstrong\u003e2b\u003c/strong\u003e: A urinary catheter (arrow) is inserted into the cecum through the incision. \u003cstrong\u003e2c\u003c/strong\u003e: An endotracheal tube is inserted into the proximal ileal segment through the incision. \u003cstrong\u003e2d\u003c/strong\u003e: The urinary catheter balloon (right arrow) is inflated with sterile water to ensure full expansion; the left arrow indicates the cecum. \u003cstrong\u003e2e\u003c/strong\u003e: The endotracheal tube balloon is inflated to ensure optimal luminal apposition to the bowel. \u003cstrong\u003e2f:\u003c/strong\u003e The pre-placed sutures are tightened and tied, securing the double-lumen tubes to the ileum. \u003cstrong\u003e2g\u003c/strong\u003e: The double-lumen tubes are passed through the stoma in the right lower abdomen, and the ileal wall is sutured to the inner peritoneum around the stoma. \u003cstrong\u003e2h:\u003c/strong\u003eThe urinary catheter (upper left arrow) and endotracheal tube (lower left arrow) are sutured and secured to the skin; the right arrow indicates the pre-placed purse-string sutures around the stoma.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5982369/v1/93ca17c360aa5f56fca64192.png"},{"id":82067867,"identity":"202a3413-69bd-4d96-8fc9-63b60bd8f53e","added_by":"auto","created_at":"2025-05-06 12:52:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":764580,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative recovery status of patients in the DTEI group. \u003cstrong\u003e3a\u003c/strong\u003e: Postoperative day 7 status; left arrow: distal tube (urinary catheter), right arrow: proximal tube (endotracheal tube) \u003cstrong\u003e3b\u003c/strong\u003e: Status after removal of both tubes; arrow: stoma site \u003cstrong\u003e3c\u003c/strong\u003e: One-month post-discharge follow-up, arrow: stoma site with complete healing \u003cstrong\u003e3d\u003c/strong\u003e: Two weeks postoperatively, rectal iodinated contrast imaging; arrow: intact colorectal anastomosis\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5982369/v1/4260fc6de35dd91d40e0e6ba.png"},{"id":99172861,"identity":"9bdf1fd9-8b26-4ac9-a36e-e1bb276c9ce7","added_by":"auto","created_at":"2025-12-29 16:11:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3631643,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5982369/v1/0661ad16-9a0f-45e7-a480-4dd1b0c3c126.pdf"},{"id":82066353,"identity":"9b414fe5-3bb9-4d1e-957f-5ccbfb694b72","added_by":"auto","created_at":"2025-05-06 12:37:16","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":440532590,"visible":true,"origin":"","legend":"","description":"","filename":"Surgicalvideo.mp4","url":"https://assets-eu.researchsquare.com/files/rs-5982369/v1/ff119e3bffc358d93f11dced.mp4"},{"id":82066165,"identity":"46e5a486-c1e1-4a88-9c23-d93da8075810","added_by":"auto","created_at":"2025-05-06 12:36:40","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14268,"visible":true,"origin":"","legend":"","description":"","filename":"DefinitionsCriteriaandNutritionPlan.docx","url":"https://assets-eu.researchsquare.com/files/rs-5982369/v1/09a18500ecc2feba2298c923.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Double-Tube End Ileostomy: An Alternative to Classical Defunctioning Stoma in Rectal Surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, advancements in surgical techniques and treatment strategies have significantly improved the prognosis of patients with low- and middle-rectal cancer (LRC) [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite these advancements, sphincter-preserving surgery for LRC still carries the risk of anastomotic leakage, primarily due to the lower position of the anastomosis and the involvement of multiple blood vessels [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Anastomotic leakage can result in severe complications, including wound infections, intra-abdominal abscesses, diffuse peritonitis, and sepsis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which may negatively impact patient outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. To mitigate the risk of anastomotic leakage and improve prognosis, diversion ileostomy is commonly performed as a preventive measure [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, patients who undergo this procedure must typically maintain the stoma for 3 to 6 months, during which they may experience complications such as peristomal dermatitis, parastomal hernia, and electrolyte imbalances [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These issues can significantly affect the patient's quality of life and increase their psychological burden [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Moreover, patients face the risks and costs associated with secondary stoma reversal surgery. Some patients are unable to undergo stoma reversal due to conditions such as rectal anastomotic stenosis, anastomotic leakage, or tumor recurrence, potentially resulting in a permanent stoma [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address these challenges, this study introduces the double-tube end ileostomy (DTEI), also known as the Zou-style stoma, as an alternative technique. This study included 18 patients who underwent DTEI, and their clinical outcomes were compared with those of patients who underwent conventional end ileostomy. The primary aim of this study was to assess the safety and efficacy of DTEI in reducing postoperative complications following total mesorectal excision (TME). Additionally, the study aimed to explore whether DTEI could serve as a viable alternative to traditional ileostomy.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design\u003c/h2\u003e\n \u003cp\u003eThis retrospective cohort study consecutively enrolled 65 patients who underwent radical rectal cancer surgery (Dixon) with prophylactic ileostomy at the First Affiliated Hospital of Anhui Medical University between March 2022 and December 2024. Patients were divided into two groups based on the type of ileostomy: 47 patients who underwent conventional ileostomy (CI group) and 18 patients who underwent double-tube end ileostomy (DTEI group). All patients were adjusted to a liquid diet 24 hours before surgery and underwent mechanical bowel preparation. The ileostomy procedures were performed immediately after the completion of radical rectal cancer surgery. The study was approved by the hospital\u0026apos;s Medical Ethics Committee (approval number: PJ2023-13-34).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eInclusion Criteria: (1) Preoperative diagnosis of primary rectal cancer confirmed by imaging and pathological biopsy;(2) Preoperative pelvic MRI and contrast-enhanced CT showing no tumor invasion at the circumferential resection margin;(3) Tumor located\u0026thinsp;\u0026le;\u0026thinsp;10 cm from the anal verge;(4) Preoperative assessment meeting criteria for sphincter-preserving surgery;(5) Underwent laparoscopic rectal cancer radical surgery with prophylactic ileostomy within the specified timeframe;(6) Completion of at least 6 months of follow-up with complete clinical data.\u003c/p\u003e\n\u003cp\u003eExclusion Criteria:(1) Tumor invasion into adjacent organs or distant metastasis; (2) Preoperative radiotherapy;(3) Severe systemic diseases (cardiovascular, neurological, hepatic, renal) contraindicating surgery;(4) Coexisting inflammatory bowel disease or familial adenomatous polyposis.\u003c/p\u003e\n\u003ch3\u003eSurgical Methods\u003c/h3\u003e\n\u003cp\u003eLow Anterior Resection for Rectal Cancer\u003c/p\u003e\n\u003cp\u003eThe surgical procedure adhered to the principles of total mesorectal excision and was conducted using the standard five-port laparoscopic approach for rectal cancer. During the procedure, the inferior mesenteric artery was ligated at a high level and divided at its root. A double-stapling technique with a stapler was employed to perform the colonic-rectal end-to-end anastomosis above the dentate line. Additionally, two to three abdominal drainage tubes were routinely placed near the anastomotic site.\u003c/p\u003e\n\u003cp\u003eDouble-Tube Ileostomy (Supplementary video)\u003c/p\u003e\n\u003cp\u003eA 1.2\u0026ndash;1.5 cm incision was made 3 cm to the right of the midline and 3 cm below the umbilicus (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ea). The cecum was laparoscopically mobilized, and the terminal ileum was exteriorized through the midline incision. A 1.0 cm incision was made on the mesenteric edge of the ileum, 15 cm from the cecum (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea). A 12 Fr disposable sterile latex urinary catheter (Shida Industrial Co., Ltd., Zhanjiang, Guangdong Province, Model: Dual-lumen Balloon Standard Edition) was used as the distal tube, and a 7.0 tracheal tube (Kohai Medical Equipment International Trade Co., Ltd., Model: 9570E) served as the proximal tube. After confirming balloon integrity, the distal tube was inserted into the cecum via the ileocecal valve (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb), and the balloon was inflated by instilling water (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ed). The proximal tube was inserted into the proximal ileum, with the balloon inflated for stability (Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ec, \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ee). Both tubes were anchored using a 4\u0026thinsp;\u0026minus;\u0026thinsp;0 absorbable purse-string suture (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ef), externalized through the right lower abdominal incision, and secured by suturing the ileal wall and peritoneum (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eg). A 10\u0026thinsp;\u0026minus;\u0026thinsp;0 silk suture was placed around the peritoneum for closure after tube removal (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ec), and the tubes were fixed to the abdominal skin (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eh).\u003c/p\u003e\n\u003cp\u003eConventional Ileostomy\u003c/p\u003e\n\u003cp\u003eA 15\u0026ndash;20 cm portion of the ileum was exteriorized through a right lower abdominal incision. A longitudinal incision was made for stoma creation, and the distal ileum was sutured closed with a standard stoma bag applied.\u003c/p\u003e\n\u003ch3\u003ePostoperative Care\u003c/h3\u003e\n\u003cp\u003eIn the DTEI group, the proximal tube was connected to a thoracic drainage bottle, and the distal tube to a drainage bag. After intestinal peristalsis resumed, a low-residue diet was followed to maintain proximal tube patency. The daily drainage volume was monitored, and if signs of proximal tube obstruction occurred, immediate flushing was performed. Within 48 hours postoperatively, 5% glucose saline (250 mL) combined with gentamicin (160,000 units) was infused and flushed through the distal tube twice daily to irrigate and flush the colon. If no anastomotic leakage or infection signs appeared within 1\u0026ndash;2 weeks post-surgery, a colon iodinated contrast study was performed via the distal tube (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003ed) to assess patency. After satisfactory results, the abdominal drainage tube was removed, and the dual-tube balloon water was aspirated bedside. Both tubes were removed (Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ec, \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eb), and the previously embedded 10# silk suture was tightened. The patient was discharged 1\u0026ndash;2 days after tube removal if no abnormalities were observed.\u003c/p\u003e\n\u003cp\u003eIn the CI group, after intestinal peristalsis resumed, enteral nutrition was gradually introduced. Regular pouch changes and stoma care were performed. Once the abdominal drainage tube was removed without complications, the patient was discharged. Regular follow-up visits, including rectal exams and imaging studies, were scheduled 3\u0026ndash;6 months later to monitor tumor recurrence or metastasis. Stoma reversal surgery was performed when appropriate.\u003c/p\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003ePatients were followed up through outpatient visits and telephone calls over a 6-month period, with assessments scheduled at the 1st and 2nd weeks, 1st month, 3rd month, and 6th month post-discharge. The data collected included anastomotic healing, complications, tumor recurrence or metastasis, and survival status. During the third follow-up, psychological status was evaluated using the Symptom Checklist-90 (SCL-90). The follow-up period concluded in December 2024.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eObservation Indicators\u003c/h2\u003e\n \u003cp\u003eIntraoperative Factors: Surgery duration, intraoperative blood loss. Postoperative Factors: Time to bowel function recovery, 24-hour abdominal drainage volume, postoperative complications (e.g., anastomotic leakage, wound infection), total length of hospital stay, and total hospitalization costs. Follow-up Factors: Stoma reversal (or tube removal), stoma-related complications, anastomotic healing, psychological status, tumor metastasis, and survival rate.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStatistical Methods\u003c/h3\u003e\n\u003cp\u003eData were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Quantitative variables were reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and compared using the t-test when normality and homogeneity of variance were confirmed; otherwise, the Mann-Whitney U test was applied. Qualitative variables were summarized as counts and percentages and analyzed using the \u0026chi;\u0026sup2; test or Fisher\u0026rsquo;s exact test where applicable. A two-sided \u003cem\u003ep\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Patient Information\u003c/h2\u003e \u003cp\u003eNo significant differences were observed between the two groups regarding baseline characteristics (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eIntraoperative Conditions\u003c/h2\u003e \u003cp\u003eBoth groups of patients successfully underwent surgery with no mortality. No statistically significant differences were observed in operation time and intraoperative blood loss between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The mean time for stoma creation in the double-tube stoma group (25.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85 minutes) was significantly shorter than in the traditional stoma group (28.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23 minutes), with the difference being statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the patients in the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCI group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDTEI group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.23\u0026thinsp;\u0026plusmn;\u0026thinsp;12.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.06\u0026thinsp;\u0026plusmn;\u0026thinsp;9.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody-mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI/II/III/IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1/30/16/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/13/5/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking,Yes/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6/41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking,Yes/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9/38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2/16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.713\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes,Yes/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8/39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2/16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.713\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior abdominal surgery,Yes/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11/36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative plasma albumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumour height from anal verge(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize of tumor (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.70\u0026thinsp;\u0026plusmn;\u0026thinsp;15.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.22\u0026thinsp;\u0026plusmn;\u0026thinsp;16.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumour stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI/II/III/IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9/18/20/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2/8/8/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor differentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWell/moderate/poor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/37/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/13/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eASA American Society of Anesthesiologists\u003c/p\u003e \u003cp\u003e \u003csup\u003eb\u003c/sup\u003eFisher exact test\u003c/p\u003e \u003cp\u003e \u003cb\u003ePostoperative Conditions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNo statistically significant differences were observed in the time to recovery of bowel function between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the traditional stoma group, 15 patients (31.9%) experienced postoperative complications, including 4 cases of anastomotic leakage (8.5%). In the double-tube stoma group, 3 patients (16.6%) experienced complications, with 1 case of anastomotic leakage (5.6%). No statistically significant differences were observed in the overall incidence of complications during hospitalization between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the total hospitalization duration and costs in the double-tube stoma group were significantly shorter and lower, respectively, than those in the traditional stoma group, with the differences being statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOperative and postoperative results of the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCI group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDTEI group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAR\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e191.06\u0026thinsp;\u0026plusmn;\u0026thinsp;40.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192.17\u0026thinsp;\u0026plusmn;\u0026thinsp;21.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.887\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerminal ileostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.34\u0026thinsp;\u0026plusmn;\u0026thinsp;50.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.78\u0026thinsp;\u0026plusmn;\u0026thinsp;58.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative abdominal drainage(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.21\u0026thinsp;\u0026plusmn;\u0026thinsp;18.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.39\u0026thinsp;\u0026plusmn;\u0026thinsp;15.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal function recovery time(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.549\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisional infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowel obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.555\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst postoperative hospital stay(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond postoperative hospital stay\u003csup\u003ec\u003c/sup\u003e(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal postoperative hospital stay(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst hospitalisation costs(rmb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54834.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9162.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57796.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5306.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond hospitalisation costs(rmb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21247.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3649.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal hospitalisation costs(rmb)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76082.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10585.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57796.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5306.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003eFisher exact test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eb\u003c/sup\u003eLow Anterior Resection\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ec\u003c/sup\u003eStoma retrieval surgery\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003eStatistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up Conditions\u003c/h2\u003e \u003cp\u003eAll 65 patients were followed up after discharge, with no reported deaths. In the traditional ileostomy group, 40 patients (85.1%) successfully underwent stoma reversal surgery. Seven patients required permanent stomas due to anastomotic stricture (5 cases), tumor recurrence (1 case), and personal reasons (1 case). The average time for stoma reversal after total rectal cancer resection was (161.5\u0026thinsp;\u0026plusmn;\u0026thinsp;23.0) days, with an average surgical cost of (21,247.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3,649.60) RMB. The average hospital stay after stoma reversal was (9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4) days. After stoma reversal, 7 patients (17.5%) developed complications, including 3 cases of intestinal obstruction, 2 cases of wound infection, 1 case of pulmonary infection, and 1 case of urinary retention. In the double-tube ileostomy group, all 18 patients successfully had their dual tubes removed, with an average tube removal time of (16.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14) days after total rectal cancer resection. No patients required a second surgery for a permanent stoma, and all stomas healed successfully after tube removal. One patient developed a stoma infection after tube removal, which resolved after symptomatic treatment. No patients experienced delayed stoma healing. During follow-up, the traditional stoma group experienced 6 cases of peristomal dermatitis, 1 case of stoma stenosis, 2 cases of stoma prolapse, 1 case of stoma retraction, and 2 cases of parastomal hernia. No long-term complications were observed in the double-tube stoma group. The difference in the incidence of long-term complications between the two groups was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFollow-up results of patients in two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCI group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDTEI group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong-term complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeristomal dermatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.175\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma prolapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStoma retraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParastomal hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic stricture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.311\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumour recurrence and metastasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eFisher exact test\u003c/p\u003e \u003cp\u003e \u003csup\u003e*\u003c/sup\u003eStatistically significant\u003c/p\u003e \u003cp\u003e \u003cb\u003ePsychological Assessment Results\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe results of the SCL-90 psychological assessment revealed that the traditional stoma group had a mean total score of 145.60\u0026thinsp;\u0026plusmn;\u0026thinsp;16.89 and 36.11\u0026thinsp;\u0026plusmn;\u0026thinsp;18.16 positive items, whereas the double-tube stoma group had a total score of 135.93\u0026thinsp;\u0026plusmn;\u0026thinsp;13.64 and 26.47\u0026thinsp;\u0026plusmn;\u0026thinsp;18.00 positive items. Comparative analysis indicated that the traditional stoma group had significantly higher total scores, as well as higher scores in the somatization factor and the sleep and eating problems factor, compared to the double-tube stoma group, with the differences being statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.No significant differences were observed between the two groups regarding baseline characteristics (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of SCL-90 scores between the two patient groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCI group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDTEI group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomatization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObsessive-compulsive symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterpersonal sensitivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.847\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHostility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParanoid ideation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychoticism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep and eating problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e145.60\u0026thinsp;\u0026plusmn;\u0026thinsp;16.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e134.56\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive symptoms total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e36.11\u0026thinsp;\u0026plusmn;\u0026thinsp;18.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e27.00\u0026thinsp;\u0026plusmn;\u0026thinsp;16.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e*\u003c/sup\u003eStatistically significant\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe use of temporary stomas after low- and mid-rectal cancer surgery to prevent anastomotic leakage remains debated [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The majority of scholars consider low- and mid-rectal cancers as independent risk factors for anastomotic leakage [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], thereby supporting the necessity of prophylactic stoma creation [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Although there is no consensus on its ability to reduce the incidence of anastomotic leakage, fecal diversion through the stoma can alleviate the severity of pelvic and abdominal infections following leakage and reduce mortality rates [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], thereby minimizing the need for surgical intervention in symptomatic anastomotic leaks (B and C types) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Opponents contend that stoma creation does not reduce the incidence of anastomotic leakage, and that its adverse effects may outweigh its potential benefits [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address this issue, several researchers [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] have sought to improve traditional stoma techniques by employing drainage tubes to replace intestinal diversion. However, a single balloon provides limited blockage of intestinal contents, and due to intestinal peristalsis, some small intestinal fluids may leak through the gap between the balloon and the intestinal wall, potentially contaminating the rectal anastomosis. In contrast, the DTEI fully utilizes the physiological and structural characteristics of the ileocecal valve, preventing the rapid influx of small intestinal contents into the colon. Additionally, it combines adjustable double balloons from endotracheal tubes and urinary catheters, achieving complete diversion of intestinal contents. This method entirely diverts intestinal fluid, effectively preventing digestive fluids and feces from contaminating and irritating the anastomosis, thereby reducing the pressure on the anastomotic site.\u003c/p\u003e \u003cp\u003eAmong 18 patients undergoing the new technique, the incidence of anastomotic leakage was lower than the reported average of 6.8\u0026ndash;19.0% [\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], likely due to complete intestinal fluid diversion and improved postoperative management. Additionally, as reported in the literature, the average time for the occurrence of anastomotic leakage is 7 days postoperatively [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In our study, we proactively conducted precise assessments of anastomotic healing within a postoperative window of 1 to 2 weeks, utilizing contrast agents or methylene blue injected through the distal tube. These assessments guided decisions on stoma tube removal.In the DTEI group, a 76-year-old male patient with diabetes developed an anastomotic leak on day 7 postoperatively, which was confirmed as a subclinical leak (Type A leak) through contrast-enhanced imaging. After conservative treatment, including continuous irrigation through the distal tube, antibiotic therapy, adequate drainage, and nutritional support, the patient successfully recovered and was discharged.In the hypothetical case of a Type B anastomotic leak, we propose that extending the tube indwelling time with the DTEI technique can provide the same protective effect on the anastomosis as traditional fistula surgeries. Additionally, a combination of fasting, antibiotic therapy, distal bowel irrigation, and other conservative measures can facilitate anastomotic healing and prevent the need for a secondary stoma. The catheter indwelling time can be adjusted based on infection control, with tube removal occurring once the lesion has stabilized, ensuring proactive and safe postoperative management.Among the 12 patients treated with the new technique in the early phase, one patient developed a direct intestinal fistula in the right lower abdomen after stoma removal, but successful healing occurred after dressing changes. Subsequently, in 6 patients, we implemented further optimization: placing purse-string sutures around the stoma margin during surgery and tightening them after tube removal, which effectively controlled intestinal fluid leakage and significantly shortened the healing time of the stoma.\u003c/p\u003e \u003cp\u003eDuring follow-up, 16 patients in the traditional stoma group experienced long-term complications related to the stoma. Furthermore, 7 patients were unable to undergo successful stoma reversal due to anastomotic stenosis or tumor recurrence, ultimately requiring a permanent stoma. In contrast, the new technique effectively prevented complications such as stoma stenosis, prolapse, and retraction by avoiding external placement of the intestinal tube [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. More importantly, this technique allows for bedside stoma tube removal, avoiding the risks associated with secondary reversal surgery. It also significantly reduced the treatment costs by approximately 21,247.66 RMB per patient and alleviated the economic burden. All 18 patients treated with the new technique successfully had their tubes removed, and their stomas closed naturally, avoiding secondary reversal surgery and improving the patients\u0026rsquo; quality of life.\u003c/p\u003e \u003cp\u003ePsychological assessments indicated greater distress in the traditional stoma group regarding mental health, somatization, and issues like sleep and diet. This difference may be attributed to the long-term stoma condition, which not only alters the patient's normal elimination pathways and body image [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], but also increases daily care demands [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and induces a sense of social isolation [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], further exacerbating psychological stress. In addition, patients often experienced sleep disturbances due to concerns about fecal leakage, stoma bag dislodgement, and displacement, making it difficult to maintain high-quality sleep, leading to physical discomfort and other symptoms [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere were no significant differences between the traditional stoma and double-tube ileostomy groups in intraoperative blood loss, recovery time, or complication incidence, suggesting comparable outcomes between Zou\u0026rsquo;s and traditional loop ileostomy. However, Zou\u0026rsquo;s ileostomy is technically simpler and avoids the cumbersome steps of multiple suturing of the intestinal tube to the abdominal wall required in traditional surgery, reducing the average operation time to (25.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85) minutes. Additionally, the new technique shows significant advantages in promoting nutritional recovery. Traditional stoma reversal is often influenced by postoperative adjuvant therapies such as radiotherapy and chemotherapy [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], and typically requires a waiting period of 3 to 6 months [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], which disrupts colonic absorption function for a prolonged period. In contrast, the new technique allows for early restoration of water reabsorption in the colon to maintain fluid balance, regulate electrolytes like sodium and potassium to prevent metabolic disturbances, absorb short-chain fatty acids to provide energy for intestinal epithelial cells and maintain mucosal barrier integrity [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and facilitate the absorption of vitamin K and B vitamins to improve the body\u0026rsquo;s nutritional status. Furthermore, by restoring the normal physiological function of the distal colon early, this technique prevents fecal incontinence or defecation difficulties that are common in traditional methods due to prolonged disuse of the anal sphincter, reducing the incidence of postoperative defecation disorders [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the currently used stoma tubes do not perfectly match the anatomical structure of the distal ileum and cecum. The proximal tube is relatively rigid, causing discomfort at the stoma site and posing a risk of tube obstruction. To address this, the team, with technical support from Hefei University of Technology and the University of Science and Technology of China, plans to further develop an intelligent warning stoma tube product for clinical application. Additionally, given the small sample size in this study, potential selection bias exists, and further multi-center studies with larger sample sizes are required to validate these conclusions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, Zou\u0026rsquo;s ileostomy technique is a promising alternative to traditional temporary ileostomy methods. It is simple to perform and effectively prevents complications such as anastomotic leakage, while avoiding secondary reversal surgery and long-term complications. This approach can significantly shorten hospitalization time, reduce both the physiological and psychological suffering of patients, and alleviate their financial burde.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorship contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u0026nbsp;\u003c/strong\u003eBingbing Zou,Yihui Xia；\u003cstrong\u003eMethodology:\u0026nbsp;\u003c/strong\u003eBingbing Zou,Hongbo Lu,Longzhen Qiu；\u003cstrong\u003eFormal analysis and investigation:\u0026nbsp;\u003c/strong\u003eYihui Xia,Yingguang Fan,Yunsheng Ding,Shouhong Wan；\u003cstrong\u003eWriting - original draft preparation:\u0026nbsp;\u003c/strong\u003eYihui Xia；\u003cstrong\u003eWriting - review and editing:\u0026nbsp;\u003c/strong\u003eBingbing Zou；\u003cstrong\u003eFunding acquisition:\u0026nbsp;\u003c/strong\u003eBingbing Zou；\u003cstrong\u003eSupervision:\u0026nbsp;\u003c/strong\u003eBingbing Zou, Hongbo Lu\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinancial support for this study was provided by the Health Research Program of Anhui (Grant No. AHWJ2024Aa40001) and the University Synergy Innovation Program of Anhui Province (Grant No. GXXT-2022-056).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp; Data is available upon request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u0026nbsp; Authors have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u0026nbsp; This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Anhui Medical University (PJ 2023-13-34).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e All authors approve the submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZheng K, Hu Q, Yu G, et al (2022) Trends of sphincter-preserving surgeries for low lying rectal cancer: A 20-year experience in China. 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Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 39:715\u0026ndash;720. https://doi.org/10.1016/j.ejso.2013.03.025\u003c/li\u003e\n \u003cli\u003eSong L, Han X, Zhang J, Tang L (2020) Body image mediates the effect of stoma status on psychological distress and quality of life in patients with colorectal cancer. Psychooncology 29:796\u0026ndash;802. https://doi.org/10.1002/pon.5352\u003c/li\u003e\n \u003cli\u003eSharpe L, Patel D, Clarke S (2011) The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas. J Psychosom Res 70:395\u0026ndash;402. https://doi.org/10.1016/j.jpsychores.2010.11.003\u003c/li\u003e\n \u003cli\u003eGessler B, Haglind E, Angenete E (2012) Loop ileostomies in colorectal cancer patients--morbidity and risk factors for nonreversal. J Surg Res 178:708\u0026ndash;714. https://doi.org/10.1016/j.jss.2012.08.018\u003c/li\u003e\n \u003cli\u003ePan H-D, Peng Y-F, Wang L, et al (2016) Risk factors for nonclosure of a temporary defunctioning ileostomy following anterior resection of rectal cancer. Dis Colon Rectum 59:94\u0026ndash;100. https://doi.org/10.1097/DCR.0000000000000520\u003c/li\u003e\n \u003cli\u003eShiomi A, Ito M, Saito N, et al (2011) Diverting stoma in rectal cancer surgery. A retrospective study of 329 patients from japanese cancer centers. Int J Colorectal Dis 26:79\u0026ndash;87. https://doi.org/10.1007/s00384-010-1036-0\u003c/li\u003e\n \u003cli\u003eDiverting ileostomy versus no diversion after low anterior resection for rectal cancer: A prospective, randomized, multicenter trial - PubMed. https://pubmed.ncbi.nlm.nih.gov/26706610/. Accessed 27 Jan 2025\u003c/li\u003e\n \u003cli\u003eMatthiessen P, Hallb\u0026ouml;\u0026ouml;k O, Ruteg\u0026aring;rd J, et al (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: A randomized multicenter trial. Ann Surg 246:207\u0026ndash;214. https://doi.org/10.1097/SLA.0b013e3180603024\u003c/li\u003e\n \u003cli\u003eHanna MH, Vinci A, Pigazzi A (2015) Diverting ileostomy in colorectal surgery: When is it necessary? Langenbecks Arch Surg 400:145\u0026ndash;152. https://doi.org/10.1007/s00423-015-1275-1\u003c/li\u003e\n \u003cli\u003eRahbari NN, Weitz J, Hohenberger W, et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the international study group of rectal cancer. Surgery 147:339\u0026ndash;351. https://doi.org/10.1016/j.surg.2009.10.012\u003c/li\u003e\n \u003cli\u003eIhn\u0026aacute;t P, Guňkov\u0026aacute; P, Peteja M, et al (2016) Diverting ileostomy in laparoscopic rectal cancer surgery: High price of protection. Surg Endosc 30:4809\u0026ndash;4816. https://doi.org/10.1007/s00464-016-4811-3\u003c/li\u003e\n \u003cli\u003eSnijders HS, Van Leersum NJ, Henneman D, et al (2015) Optimal Treatment Strategy in Rectal Cancer Surgery: Should We Be Cowboys or Chickens? Ann Surg Oncol 22:3582\u0026ndash;3589. https://doi.org/10.1245/s10434-015-4385-7\u003c/li\u003e\n \u003cli\u003eWang D, Huang Y, Wang W, et al (2018) Application value of the modified terminal cannula ileostomy in laparoscopic anus-preserving operation of low rectal cancer. Chin J Dig Surg 17:. https://doi.org/10.3760/cma.j.issn.173-9752.2018.02.013\u003c/li\u003e\n \u003cli\u003eLiu L, Huang Q, Wang J, et al (2016) Protection of low rectal anastomosis with a new tube ileostomy using a biofragmentable anastomosis ring: A retrospective study. Medicine (Baltimore) 95:e5345. https://doi.org/10.1097/MD.0000000000005345\u003c/li\u003e\n \u003cli\u003eZhao S, Zhang L, Gao F, et al (2021) Transanal drainage tube use for preventing anastomotic leakage after laparoscopic low anterior resection in patients with rectal cancer: A randomized clinical trial. JAMA Surg 156:1151\u0026ndash;1158. https://doi.org/10.1001/jamasurg.2021.4568\u003c/li\u003e\n \u003cli\u003eDegiuli M, Elmore U, De Luca R, et al (2022) Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study): A nationwide retrospective study of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group. Colorectal Dis Off J Assoc Coloproctology G B Irel 24:264\u0026ndash;276. https://doi.org/10.1111/codi.15997\u003c/li\u003e\n \u003cli\u003eWu Y, Zheng H, Guo T, et al (2017) Temporary diverting stoma improves recovery of anastomotic leakage after anterior resection for rectal cancer. Sci Rep 7:15930. https://doi.org/10.1038/s41598-017-16311-7\u003c/li\u003e\n \u003cli\u003eMathew AP, M S, K C, et al (2022) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Indian J Surg Oncol 13:468\u0026ndash;473. https://doi.org/10.1007/s13193-022-01501-1\u003c/li\u003e\n \u003cli\u003eThalheimer A, Bueter M, Kortuem M, et al (2006) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum 49:1011\u0026ndash;1017. https://doi.org/10.1007/s10350-006-0541-2\u003c/li\u003e\n \u003cli\u003eRafiei H, Rashvand F, Malmir S (2020) Quality of life of family caregivers of patients with a stoma: A cross-sectional study from iran. Br J Nurs Mark Allen Publ 29:S27\u0026ndash;S30. https://doi.org/10.12968/bjon.2020.29.22.S27\u003c/li\u003e\n \u003cli\u003eLi G, He X, Qin R, et al (2024) Linking stigma to social isolation among colorectal cancer survivors with permanent stomas: The chain mediating roles of stoma acceptance and valuable actions. J Cancer Surviv Res Pract. https://doi.org/10.1007/s11764-024-01614-2\u003c/li\u003e\n \u003cli\u003eAlwi F, Setiawan, Asrizal (2018) Quality of life of persons with permanent colostomy: A phenomenological study. J Coloproctology 38:295\u0026ndash;301. https://doi.org/10.1016/j.jcol.2018.06.001\u003c/li\u003e\n \u003cli\u003eHerrle F, Sandra-Petrescu F, Weiss C, et al (2016) Quality of life and timing of stoma closure in patients with rectal cancer undergoing low anterior resection with diverting stoma: A multicenter longitudinal observational study. Dis Colon Rectum 59:281\u0026ndash;290. https://doi.org/10.1097/DCR.0000000000000545\u003c/li\u003e\n \u003cli\u003eKeane C, Park J, \u0026Ouml;berg S, et al (2019) Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg 106:645\u0026ndash;652. https://doi.org/10.1002/bjs.11092\u003c/li\u003e\n \u003cli\u003eDavid GG, Slavin JP, Willmott S, et al (2010) Loop ileostomy following anterior resection: Is it really temporary? Colorectal Dis Off J Assoc Coloproctology G B Irel 12:428\u0026ndash;432. https://doi.org/10.1111/j.1463-1318.2009.01815.x\u003c/li\u003e\n \u003cli\u003eSeethaler B, Nguyen NK, Basrai M, et al (2022) Short-chain fatty acids are key mediators of the favorable effects of the mediterranean diet on intestinal barrier integrity: Data from the randomized controlled LIBRE trial. Am J Clin Nutr 116:928\u0026ndash;942. https://doi.org/10.1093/ajcn/nqac175\u003c/li\u003e\n \u003cli\u003eVogel I, Reeves N, Tanis PJ, et al (2021) Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: A systematic review and meta-analysis. Tech Coloproctology 25:751\u0026ndash;760. https://doi.org/10.1007/s10151-021-02436-5\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"anastomotic leak, ileostomy, low rectal cancer, stoma reversal surgery","lastPublishedDoi":"10.21203/rs.3.rs-5982369/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5982369/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study compares the clinical benefits of double-tube end ileostomy versus traditional end ileostomy in patients undergoing low anterior resection for rectal cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA retrospective analysis was conducted on 65 patients who underwent laparoscopic radical rectal cancer surgery with preventive ileostomy between March 2022 and December 2024 at the First Affiliated Hospital of Anhui Medical University. Of these, 47 patients received traditional ileostomy, while 18 patients underwent double-tube ileostomy. The clinical characteristics and follow-up outcomes of the two groups were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eBoth groups showed no significant differences in intraoperative blood loss, postoperative bowel function recovery, or complication rates (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05). However, the double-tube ileostomy group had superior outcomes: average stoma creation time was 25.39±2.85 minutes, postoperative hospital stays averaged 8.89±2.30 days, and total hospitalization costs were 57796.50±5306.30 RMB, all significantly lower than in the traditional ileostomy group (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01). Complications were fewer in the double-tube group, with only one case of type A anastomotic leakage (5.56%) and no long-term complications following successful tube removal. In contrast, the traditional group had four cases of leakage (8.51%), and 16 patients experienced long-term complications, with only 40 (85.11%) achieving successful stoma closures. Furthermore, traditional group patients reported higher SCL-90 scores for somatization and sleep and eating problems (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05), indicating significant differences between the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Double-tube end ileostomy offers a safe and effective alternative to traditional methods, with shorter operative times, fewer secondary surgeries, and reduced physiological, psychological, and financial burdens on patients.\u003c/p\u003e","manuscriptTitle":"Double-Tube End Ileostomy: An Alternative to Classical Defunctioning Stoma in Rectal Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 12:36:36","doi":"10.21203/rs.3.rs-5982369/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-16T20:52:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-15T19:05:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272220823695753698703252853035748396918","date":"2025-05-05T12:57:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-28T16:59:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-16T06:21:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Techniques in Coloproctology","date":"2025-04-15T10:57:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0a70b563-7b68-4cfa-85a7-35ac007d9715","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:08:32+00:00","versionOfRecord":{"articleIdentity":"rs-5982369","link":"https://doi.org/10.1007/s10151-025-03267-4","journal":{"identity":"techniques-in-coloproctology","isVorOnly":false,"title":"Techniques in Coloproctology"},"publishedOn":"2025-12-27 15:58:12","publishedOnDateReadable":"December 27th, 2025"},"versionCreatedAt":"2025-05-06 12:36:36","video":"","vorDoi":"10.1007/s10151-025-03267-4","vorDoiUrl":"https://doi.org/10.1007/s10151-025-03267-4","workflowStages":[]},"version":"v1","identity":"rs-5982369","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5982369","identity":"rs-5982369","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}