“Fecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Some of the most common applications for the use of a diverting stoma include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer with the conclusion that diverting loop ileostomy is preferred to loop colostomy” (Plasencia)

“The use of diversion encompasses many clinical scenarios and needs to be carefully considered and individualized. In this article, we have discussed the most common scenarios that colorectal surgeons face daily. We conclude the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis and IPAA, severe perianal CD frequently requires diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular perforation is safe, and a diverting stoma can be used as a bridge to primary resection in the setting of an obstructing malignancy.” (Plasencia )

Plasencia A, et al Diverting Ostomy: For Whom, When, What, Where, and Why. Clin Colon Rectal Surg. 2019 May;32(3):171-175. doi: 10.1055/s-0038-1677004. Epub 2019 Apr 2. Free Full Text