J Korean Surg Soc 2012;83:88-91 http://dx.doi.org/10.4174/jkss.2012.83.2.88 ORIGINAL ARTICLE JKSS Journal of the Korean Surgical Society pISSN 2233-7903ㆍeISSN 2093-0488 Routine barium enema prior to closure of defunctioning ileostomy is not necessary Sung Yeon Hong, Do Yun Kim, Seung Yeop Oh, Kwang Wook Suh Department of Surgery, Ajou University School of Medicine, Suwon, Korea Purpose: The use of barium enemas to confirm the anastomotic integrity prior to ileostomy closure is still controversial. The purpose of the study was to determine the utility of routine contrast enema prior to ileostomy closure and its impact on pa- tient management in patients with a low pelvic anastomosis. Methods: One hundred forty-five patients had a temporary loop ileostomy constructed to protect a low colorectal or coloanal anastomosis following low anterior resection for rectal cancer. All patients were evaluated by physical examination, proctoscopy, and barium enema prior to ileostomy closure. Results: The median time from ileostomy creation to closure was 8 months. Five (3.5%) of the 144 patients were found to have clinically relevant strictures at the colorectal anastomosis on routine barium enema. One patient (0.7%) showed anastomotic leak on their barium enema. Overall, 141 patients (97.9%) had an uncomplicated postoperative course. Postoperative compli- cation occurred in three patients (2.1%). None of them showed abnormal barium enema finding, which suggested that rou- tine contrast enema examination did not predict postoperative complication. Conclusion: Routine barium enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information for postoperative color- ectal anastomotic complication. Key Words: Ileostomy closure, Protective ileostomy, Barium enema, Anastomotic leak INTRODUCTION motic leak rate and reoperation rate [7]. Covering stomas are routinely closed at 8 to 12 weeks after the initial Low anterior resection is the operation of choice for low surgery. Before stoma closure, the distal anastomosis is rectal cancer, the formation of a straight anastomosis or routinely evaluated to rule out anastomotic leak or fistula colopouch anal anastomosis with total mesorectal excision formation by physical examination, proctoscopy, and ra- is regarded the procedure of choice for such lesions [1,2]. diographically by contrast enema. Previous studies have However, the major complication of mesorectal excision is shown that contrast enema examinations are useful for de- a significant anastomotic leak rate [3,4]. Anastomotic leak tecting many of these complications before takedown of is a recognized complication of anterior resection with the diverting ileostomy. However, it is unclear whether published rates varying from 2.8 to 25% [5,6]. this should be performed selectively or routinely. A defunctioning stoma is recommended after low ante- The use of barium enema to confirm the anastomotic in- rior resection for rectal cancer to decrease clinical anasto- tegrity prior to ileostomy closure is still controversial. The pur- Received March 21, 2012, Revised May 20, 2012, Accepted May 26, 2012 Correspondence to: Seung Yeop Oh Department of Surgery, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 443-721, Korea Tel: ＋82-31-219-5205, Fax: ＋82-31-219-5755, E-mail: kgsosy@ajou.ac.kr cc Journal of the Korean Surgical Society is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2012, the Korean Surgical Society