In low anterior resection with a defunctioning loop ileostomy, the ileostomy is most commonly fashioned at which position and level?

• A Left iliac fossa, using the sigmoid colon
• B Right iliac fossa, at the terminal ileum 10 cm from the ileocaecal valve
• C Right iliac fossa, at the level of the distal ileum 20–30 cm from the ileocaecal valve ✓
• D Right hypochondrium through the rectus abdominis muscle

Explanation

A defunctioning loop ileostomy is fashioned in the right iliac fossa using a loop of distal ileum, typically 20–30 cm from the ileocaecal valve, which provides sufficient length for an easy spout stoma without tension. This loop is brought through the rectus abdominis muscle at the right iliac fossa pre-marked site to reduce the risk of herniation and retraction. Terminal ileum within 10 cm of the ileocaecal valve is avoided to prevent ileostomy diarrhoea from impaired bile salt reabsorption. A left iliac fossa sigmoid stoma would create a colostomy, not an ileostomy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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