Postoperative Outcomes of Double-Barreled Wet Colostomy Versus Ileal Conduit After Pelvic Exenteration: A Systematic Review and Meta-analysis.

Ileal conduit (IC) remains the standard urinary diversion after pelvic exenteration, but double-barreled wet colostomy (DBWC) has regained interest as a viable alternative when simultaneous fecal diversion is required, as it allows the diversion of both urinary and digestive tracts through a single stoma, thereby simplifying postoperative management and reducing the overall functional burden on patients. To compare postoperative complications and operative outcomes of these two procedures, a systematic search was conducted across PubMed, Scopus, and the Cochrane Central Register of Controlled Trials for studies published up to March 2025. Pooled odds ratios (ORs) and mean differences (MDs), along with 95% confidence intervals (CIs), were calculated using random-effects models, with heterogeneity assessed by the I² statistic, and analyses performed with R software, Version 4.4.1 (R Foundation for Statistical Computing, Vienna, Austria, https://www.R-project.org/). This review ultimately included five retrospective observational studies with 345 patients, of whom 195 (56.5%) underwent DBWC and 150 (43.4%) underwent IC. The analysis found no significant differences between DBWC and IC for several key outcomes, including urinary leak (OR 0.38; 95% CI 0.13-1.05; p = 0.06), pyelonephritis (OR 0.43; 95% CI 0.18-1.08; p = 0.07), uretero-enteric stenosis (OR 0.99; 95% CI 0.21-4.61; p = 0.98), severe complications (Clavien-Dindo ≥ III) (OR 1.54; 95% CI 0.70-3.39; p = 0.28), electrolyte disturbances (OR 0.74; 95% CI 0.27-2.02; p = 0.55), hospital stay (MD -4.46 days; 95% CI -12.77 to 3.84; p = 0.29), operative time (MD 6.28 minutes; 95% CI -157.74 to 170.29; p = 0.94), and mortality (OR 0.55; 95% CI 0.18-1.70; p = 0.30). Notably, sensitivity analysis revealed that DBWC was associated with a significantly lower risk of intestinal leak after the exclusion of one influential study (OR 0.21; 95% CI 0.07-0.67; I² = 0%). In conclusion, the findings suggest that DBWC is a safe and feasible alternative to IC for urinary reconstruction after pelvic exenteration, with comparable postoperative outcomes.