This current study included 590 patients from six studies. After pooling analysis, we found that patients in the OM Group had a shorter operative time in both the primary rectal cancer surgery and in the stoma reversal surgery. Moreover, patients in the OM group had fewer stoma-related complications than patients in the TM group.

Temporary ileostomy, as a measure for stool diversion, could prevent the reoperation, because bowel contents will not contaminate the peritoneal cavity and result in septic shock [26, 27]. The average interval time to stoma closure was three to four months [28, 29]. Although the temporary ileostomy surgery was safe for patients after LLAR [30], the stoma-related complications and stoma reversal-related complications influenced the patients’ quality of life [31, 32]. The TM of ileostomy was performed by intermittently suturing the peritoneum, anterior sheath and skin layer, respectively [33]. This surgical method was time-spending, stitch-needing, and relatively difficult in such obese patients [16, 34, 35]. Studies had shown that the OM of ileostomy, which only needed one stitch to finish the surgery procedure, could reduce the operation time and save the sutures [17, 18]. The primary LLAR operation time and the ileostomy operation time were reduced due to the simplification of the ostomy procedure. As for the reduction in the time of the second stoma reversal operation, one of the reasons might be that the OM could reduce the degree of tissue adhesion around the stoma. However, whether the OM affected the stoma-related complications, there existed an argument.

Wang CJ et al [21] and Zhang L et al [20] reported that the overall incidence of stoma-related complications in the OM group was lower than in the TM group. In addition, other four studies thought there were no difference between the two groups when considering overall stoma-related complications [16,17,18,19]. Interestingly, Li XM et al. demonstrated that the OM group had lower incidence of skin irritation [18]. Moreover, Pei WT et al [16] conducted a subgroup analysis in BMI obese group and non-group, and they found that no obvious difference was detected in stoma-related complications either. The mechanism of stoma-related complications was unclear yet.

The stoma-related complications included early complications and delayed complications [36]. The early stoma-related complications included stoma retraction, stoma necrosis, stoma skin irritation and mucocutaneous separation, stoma edema, stoma bleeding, and stoma infection [37, 38]. The delayed complications included stoma stricture, stoma prolapse, and parastomal hernia [39]. Compared with the TM, on the one hand, the OM could string the peritoneum and anterior sheath layer [40]. On the other hand, the TM was particularly difficult due to thick abdominal fat and mesangial contracture in obese people, and the suture of peritoneum and anterior sheath was not satisfactory. Different from the TM, the OM effectively sidestepped this physiological difference. Therefore, the early stoma-related complications would be less in the OM group. However, the internal stability in OM was relatively poorer than TM. When the interval time to stoma reversal increased, the incidence of delayed complications would increase in the OM group. That was also the reason why the OM did not fit with colostomy [41]. It is worth noting that to avoid serous edema and serositis, the tying procedure should not be excessively tight. In addition, patients should be instructed to take early bed rest and choose the appropriate position after the operation of the ileostomy, avoid stoma contamination, replace the stoma bag in time, observe the surrounding skin and blood flow, pay close attention to the situation of the stoma, and actively prevent the occurrence of complications such as necrosis and edema.

To our knowledge, this current study was the first one to summarize the association between the stoma-related complications and method of temporary ileostomy. Meanwhile, some limitations existed in this study. First, all the six studies were retrospective studies and were from China, and the sample size of the included studies was relatively small, so more detailed randomized controlled trials from other regions were needed for comprehensive analysis. Second, the operation time of each ileostomy procedure was lacking. And third, the information of detailed complications was lacking in almost the studies we included, so we could not conduct a subgroup analysis in the detailed complications, early complications, and delayed complications.

In conclusion, the OM group had shorter operation time in both the primary LLAR surgery and the stoma reversal surgery than the TM group. Moreover, the OM group had less overall stoma-related complications. This surgical method was safe, effective, and worth promoting in clinical works.