title: Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer.
abstract: OBJECTIVE
  The current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer.
  
  
  METHODS
  All patients who underwent a laparoscopic low anterior resection for rectal cancer with a diverting ileostomy between 2007 and 2014 were abstracted. The patients who underwent and did not undergo a diverting ileostomy procedure were compared regarding patient, tumor, treatment related parameters, and survival.
  
  
  RESULTS
  Among 160 (103 males [64.4%], mean [± standard deviation] age was 58.1 ± 11.9 years) patients, stoma reversal was achieved in 136 cases (85%). Anastomotic stricture (n = 13, 52.4%) was the most common reason for stoma reversal. These were the risk factors for the failure of stoma reversal: Male sex (P = 0.035), having complications (P = 0.01), particularly an anastomotic leak (P < 0.001), or surgical site infection (P = 0.019) especially evisceration (P = 0.011), requirement for reoperation (P = 0.003) and longer hospital stay (P = 0.004). Multivariate analysis revealed that male sex (odds ratio [OR], 7.82; P = 0.022) and additional organ resection (OR, 6.71; P = 0.027) were the risk factors. Five-year survival rates were similar (P = 0.143).
  
  
  CONCLUSIONS
  Fifteen percent of patients cannot receive a stoma reversal after laparoscopic low anterior resection for rectal cancer. Anastomotic stricture is the most common reason for the failure of stoma takedown. Having complications, particularly an anastomotic leak and the necessity of reoperation, limits the stoma closure rate. Male sex and additional organ resection are the risk factors for the failure in multivariate analyses. These patients require a longer hospitalization period, but have similar survival rates as those who receive stoma closure procedure.
authors.affiliation: Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.; Department of General Surgery, Medipol University Medical School, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Haksal
authors.affiliation: Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Nuri
authors.initials: N
authors.lastname: Okkabaz
authors.affiliation: Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ali Emre
authors.initials: AE
authors.lastname: Atici
authors.affiliation: Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Civil
authors.affiliation: Department of General Surgery, Medipol University Medical School, Istanbul, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Ozdenkaya
authors.affiliation: Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erdemir
authors.affiliation: Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Nihat
authors.initials: N
authors.lastname: Aksakal
authors.affiliation: Department of General Surgery, Medipol University Medical School, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Oncel
keywords: Ileostomy; Laparoscopy; Rectal neoplasms