title: Indications of a Defunctioning Stoma in Colorectal Anastomosis--Our Experience and Review of the Literature.
abstract: BACKGROUND
  Defunctioning stomas can prevent consequences of anastomotic leakage, but they are not free of complications.
  
  
  OBJECTIVE
  The identification of high-risk patients to establish criteria for strong and relative indications for the formation of a defunctioning stoma.
  
  
  METHODS
  Two hundred fifty consecutive colorectal anastomoses were performed between 2004 and 2015; 95.2% of these were for colorectal cancer. In 130 cases, mechanical anastomosis was used. A protective stoma was performed in only 15 cases. The incidence of anastomotic leakage was evaluated according to multiple parameters, as were the postoperative complications related to protective stomas. The outcomes were compared to those reported in the literature.
  
  
  RESULTS
  Symptomatic anastomotic leakage occurred in six patients (2.4%) and resulted in four deaths. None of the patients with a protective stoma developed serious complications related to the colorectal anastomosis. However, serious ileostomy-related complications occurred in two cases (15.38%).
  
  
  CONCLUSIONS
  Protective stomas should be used only according to the risk criteria of the patients. Strong indications are: anastomotic imperfections, anastomosis under tension, previous pelvic irradiation, ultralow anastomosis in patients older than 70 years, patients over 80 years, and significant co-morbidities.
authors.forename: Marius F
authors.initials: MF
authors.lastname: Coroş
authors.forename: Sorin
authors.initials: S
authors.lastname: Sorlea
authors.forename: Alexandru
authors.initials: A
authors.lastname: Hintea
authors.forename: Rareş
authors.initials: R
authors.lastname: Georgescu
authors.forename: Călin
authors.initials: C
authors.lastname: Crăciun
authors.forename: Ghenadie
authors.initials: G
authors.lastname: Pascarenco
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D054047:Surgical Stomas / Q000009:adverse effects / Q000473:pathology; D015996:Survival Rate; D016896:Treatment Outcome