The effects of stoma on body perception and cosmesis in patients with laparoscopic or open rectum resection

Objective: Colorectal cancers are the third most common cancer in men and second in women and ranks third in cancer-related deaths in both sexes. Chemoradiotherapy is applied in the preoperative period (neoadjuvant) in order to reduce local recurrence of rectal cancers and to provide a survival advantage. The effects of chemoradiotherapy applied, comorbid diseases, alcohol and cigarette use, obesity, preoperative malnutrition, and surgical technique may adversely affect the healing of anastomosis between the colon and rectum. In order to avoid any leakages that may occur in this anastomosis, diverting ileostomy is opened. The primary purpose of our study is to determine the effect of diverting ileostomy on body perception and cosmezis in patients with open or laparoscopic rectum resection surgery. The secondary aim is to determine to what extent the opening and closing of diverting ileostomy in patients undergoing laparoscopic rectum surgery reduces the positive effects of laparoscopic surgery on body perception and cosmezis. Materials and Methods: In our study, ten questions "Body Image Score Questionnaire", consisting of body appearance, cosmezis and self-confidence scoring were applied to the patients who underwent elective oncological surgery due to rectum cancer, which were performed by DEUTF General Surgery Department Colorectal Unit between January 2013 and December 2017. Patients included in the study were divided into two groups as open (Group 1) and laparoscopic (Group 2) according to the type of surgery performed, each group as those who underwent ileostomy (Group 1b, Group 2b) and those who did not (Group 1a, Group 2a). During the study, ileostomy of all patients with ileostomy were closed. Patients' age, gender, height, weight, open/laparoscopic surgery, presence of diverting ileostomy, tumor localization, T and N stage, patients' neoadjuvant and/or adjuvant chemoradiotherapy were recorded. Statistics were done using SPSS 22.0. Results: The age range of 129 patients operated was 32-88, and the mean age was 61, and the female/ ale ratio was 39/63. 101 (78.3%) of the patients were operated openly (Group 1), and 28 (21.7%) were operated laparoscopically (Group 2). When the subgroup (Group 2) undergoing laparoscopic surgery was examined; it was observed that the questionnaire scores of the group who had diverting ileostomy with and without opening did not have a statistically significant difference. When the subgroup (Grup 1) undergoing open surgery was examined; it was observed that the questionnaire scores did not contain any statistically significant difference between the group with divergent ileostomy was opened and not opened. When all subgroups are compared; it was observed that the scores on the body appearance , the cosmezis and the self-confidence were close to each other, so the questionnaire scores were not statistically significant. When Group 1b and Group 2a are compared as two extreme groups in the study; it was observed that the scores on the body appearance score, the cosmezis score and the self-confidence score were close to each other, so the questionnaire scores were not statistically significant. Key Words : Rectal cancer, diverting ileostomy, cosmesis