Role of Defunctioning Stoma

The worst complication of colorectal surgery is represented by an anastomotic leak and consequent pelvic infection; the incidence increases after ultra-low colorectal or colo-anal anastomosis, particularly when the exeresis of the mesorectum is complete, due probably to the devascularisation of the residual rectal stump [24].

The incidence of radiologic anastomotic leakage after total mesorectum excision and colo-anal anastomosis is about 16% vs. 8% in patients who did not undergo TME [25].

Protective stoma has the purpose of decreasing the consequences of an anastomotic leakage, which not only determines a pelvic peritonitis with a high degree of mortality (about 50%) but causes anorectal fibrotic stenosis [26]. In a recent study of about 2 000 patients, Eriksen et al. [27] presents an incidence of clinical dehiscence of 11.6%, showing that defunctioning stoma not only decreases the consequences of an anastomotic leakage but also reduces the risk of a leakage itself by 60%. Peeters et al. confirms this result and shows defunctioning stoma is related to a lower requirement of surgical reintervention [28]. For this reason a routine defunctioning ileostomy is advised and it may be electively closed after 4-6 weeks.

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