Although avoiding a permanent stoma is often taken sine qua non for a good outcome after rectal cancer surgery, functional success must be considered separately. Functional disturbances after low anterior resection (LAR) like frequency of bowel action, diarrhoea, faecal incontinence and even constipation have been reported [19, 20]. Low colorectal or colo-anal anastomoses especially are associated with worse functional results than a high anterior resection . Thus it is important to evaluate the sphincter function to avoid permanent faecal incontinence, as a sphincter-sparing operation in a patient with poor sphincter function does not make sense .
On the other hand, it must be made clear that in a patient with a very low anastomosis, the risk of an anastomotic insufficiency is high. To avoid late postoperative problems (e.g. urgency, frequent evacuations etc.) we therefore suggest in these cases the liberal creation of a temporary stoma .
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