Complications and surgical optimization of terminal ileostomy: focus on the one-stitch technique

Abstract:

Terminal ileostomy is an essential strategy in sphincter-preserving surgery for low rectal cancer to reduce the severity of anastomotic leakage and reoperation rates. However, it is associated with various complications, including peristomal skin injury, high-output stoma, stoma retraction or necrosis, prolapse, parastomal hernia, and stoma reversal-related complications, which impair quality of life and increase healthcare burden. With the rising incidence of rectal cancer and increasing use of sphincter-preserving procedures, optimizing ileostomy-related management has become increasingly important. In recent years, based on fundamental principles of stoma construction, the one-stitch technique and its modifications have been proposed and gradually adopted in China to simplify procedures, shorten operative time, and reduce mucocutaneous separation, leakage and the incidence of stoma retraction by achieving loop exteriorization and fixation with a single suture. This review summarizes ileostomy- and reversal-related complications, risk factors, and management strategies, with a particular focus on the technical details and clinical evidence of the one-stitch technique, aiming to provide references for optimizing surgical strategies.