title: The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer.
abstract: Anastomotic leakage (AL) is a severe complication after low anterior resection (LAR) in rectal cancer surgery. A diverting loop ileostomy has been reported to reduce early clinical AL and thereby decrease short-term morbidity. Less is known if long-term morbidity is affected by a loop ileostomy constructed at LAR.
  
  
  
  At Ersta Hospital, Sweden, 287 consecutive patients were operated on with LAR, 2002-2011. Follow-up time was 3 years after LAR. Due to a shift in routines, 15% were diverted at LAR, 2002-2006 and 91%, 2007-2011. Data on long-term morbidity and permanent stoma in patients with or without a diversion at primary surgery were compared.
  
  
  
  During LAR, 139 patients were diverted (S+), 148 were not (S-). Total rate of AL, both early and late, was 26% in S+ and 30% in S-, p 0.25. Late AL (>30 days after LAR) was found in 6% and 15% were readmitted in the late postoperative period with no difference between the groups. Total length of hospital stay (30 days-3 years after LAR) was longer among S+ compared to S-, mean 7 vs. 4 days (p < 0.001). One out of six ended up with a permanent stoma (17% S+, 14% S-, p 0.47). Clinical AL was an independent risk factor and the most common cause for a permanent stoma in both groups.
  
  
  
  A diverting loop ileostomy at LAR did not reduce long-term morbidity but was associated with a longer total length of hospital stay during a 3-year follow up.
authors.affiliation: Center for Digestive Diseases, Karolinska University Hospital, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden. Electronic address: kajsa.anderin@karolinska.se.
authors.forename: K
authors.initials: K
authors.lastname: Anderin
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden; Department of Surgery, Danderyd Hospital, Sweden.
authors.forename: U O
authors.initials: UO
authors.lastname: Gustafsson
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden; Department of Surgery, Ersta Hospital, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Thorell
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden; Department of Surgery, Ersta Hospital, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Nygren
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D006801:Humans; D007081:Ileostomy; D011183:Postoperative Complications; D012004:Rectal Neoplasms; D012189:Retrospective Studies; D054047:Surgical Stomas
keywords: Long-term morbidity; Low anterior resection