Selective temporary protective loop ileostomy in complex rectal resection for deep infiltrating endometriosis: a prospective matched cohort study on bowel function, quality of life, and postoperative complications

Hawezy DJ, Dawan Jamal Hawezy, Waleed Baqer, Baqer W, Fatah AO, Araz Omar Fatah, Marwa Fadhil Alsaffar, Alsaffar MF
BMC surgery · 2026 · vol. 26(1) · doi:10.1186/s12893-026-03641-5 · PMID:42151942 · PMC13352846 · W7161589425
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This prospective study found that temporary protective loop ileostomy in women with deep infiltrating endometriosis undergoing rectal resection did not significantly impact bowel function or quality of life compared to no ileostomy.

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Abstract

BACKGROUND: This study aimed to evaluate the impact of temporary protective loop ileostomy (PLI) on postoperative complications, bowel function, and quality of life (QoL) in women undergoing rectal surgery for deep infiltrating endometriosis (DIE) requiring concomitant vaginal and rectal repair. METHODS: In this prospective observational cohort study conducted at Baghdad Teaching Hospital, Medical City, and Kamal Al-Samarrai Hospital (April 2023-April 2024), 230 women underwent colorectal endometriosis surgery. From this population, 42 women with technically feasible colorectal anastomoses were selected; 21 who received a temporary protective loop ileostomy (PLI) were matched 1:1 by age and key risk factors to 21 women without PLI (WPLI). Postoperative outcomes, including the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC-BFI score) and QoL (EHP-5 score), were assessed using validated Arabic versions of psychometric instruments at baseline and one year postoperatively. Surgical complications were classified per Clavien-Dindo criteria. RESULTS: Both groups demonstrated significant improvement in pain symptoms, bowel function, and QoL at 12-month follow-up (p  0.05) and EHP-5 scores (28.1 ± 5.3 vs. 31.3 ± 4.3; p > 0.05) should be interpreted as exploratory trends given limited power. Postoperative complication rates (9.5% vs. 14.3%; p = 0.211) suggest a possible pattern. CONCLUSIONS: In women with DIE and technically feasible colorectal anastomoses, selective use of temporary protective loop ileostomy was not associated with significant detriment to bowel function or QoL in this small matched cohort and may be linked to lower rates of severe anastomotic complications. Given the limited sample size and observational design, these findings should be considered preliminary. Larger, adequately powered randomized trials with extended follow-up are warranted to confirm these observations.
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Abstract

Background This study aimed to evaluate the impact of temporary protective loop ileostomy (PLI) on postoperative complications, bowel function, and quality of life (QoL) in women undergoing rectal surgery for deep infiltrating endometriosis (DIE) requiring concomitant vaginal and rectal repair.

Methods

In this prospective observational cohort study conducted at Baghdad Teaching Hospital, Medical City, and Kamal Al-Samarrai Hospital (April 2023–April 2024), 230 women underwent colorectal endometriosis surgery. From this population, 42 women with technically feasible colorectal anastomoses were selected; 21 who received a temporary protective loop ileostomy (PLI) were matched 1:1 by age and key risk factors to 21 women without PLI (WPLI). Postoperative outcomes, including the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC-BFI score) and QoL (EHP-5 score), were assessed using validated Arabic versions of psychometric instruments at baseline and one year postoperatively. Surgical complications were classified per Clavien-Dindo criteria.

Results

Both groups demonstrated significant improvement in pain symptoms, bowel function, and QoL at 12-month follow-up (p 0.05) and EHP-5 scores (28.1 ± 5.3 vs. 31.3 ± 4.3; p > 0.05) should be interpreted as exploratory trends given limited power. Postoperative complication rates (9.5% vs. 14.3%; p = 0.211) suggest a possible pattern.

Conclusions

In women with DIE and technically feasible colorectal anastomoses, selective use of temporary protective loop ileostomy was not associated with significant detriment to bowel function or QoL in this small matched cohort and may be linked to lower rates of severe anastomotic complications. Given the limited sample size and observational design, these findings should be considered preliminary. Larger, adequately powered randomized trials with extended follow-up are warranted to confirm these observations. Similar content being viewed by others Abbreviations - PLI: - Protective loop ileostomy - WPLI: - Without protective loop ileostomy - QoL: - Quality of life - DIE: - Deep infiltrating endometriosis - MSKCC-BFI: - Memorial Sloan Kettering Cancer Center Bowel Function Instrument - EHP-5: - Endometriosis Health Profile-5 Funding No funding. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical standards of the Declaration of Helsinki and approved by the Ethics Committee of the General Medical College of Koya University, Kurdistan Region, Iraq (Approval No. 25/1011, dated March 10, 2023). Written informed consent was obtained from all participants prior to enrollment, including consent for surgical intervention, participation in the study, and use of anonymized clinical and questionnaire data for research purposes. Consent for publication All participants provided written informed consent for the publication of anonymized data obtained during the study. No personal identifying information is included in this manuscript. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Hawezy, D.J., Baqer, W., Fatah, A.O. et al. Selective temporary protective loop ileostomy in complex rectal resection for deep infiltrating endometriosis: a prospective matched cohort study on bowel function, quality of life, and postoperative complications. BMC Surg (2026). https://doi.org/10.1186/s12893-026-03641-5 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12893-026-03641-5

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Outcome instruments

EHP-30

Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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References (33)

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noordeloos 2009062

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