Int J Colorectal Dis (2012) 27:49–54 Table 4 Patient- and surgery- related risk factors for compli- cations after stoma closure in 138 patients a American Society of Anesthesiology Variables Gender Male Female Age (years) Median (range) ASAa class I II III Primary diagnosis Inflammatory bowel disease Colorectal cancer Familial adenomatous polyposis Other Type of primary surgery Ileal pouch-anal anastomosis Low colorectal anastomosis Setting of stoma creation Elective (prophylactic) Acute (anastomotic complications) Surgeon Resident Colorectal surgeon Time to stoma closure (weeks) Median (range) Anastomotic technique Hand-sewn Stapled Noncomplicated (n=110) Complicated (n=28) 60 (54.5) 50 (45.5) 46.8 (20–85) 27 (24.5) 74 (67.3) 9 (8.2) 57 (51.8) 37 (33.6) 8 (7.3) 8 (7.3) 60 (54.5) 50 (45.5) 88 (80.0) 22 (20.0) 101 (91.8) 9 (8.2) 16.6 (1–70) 100 (90.9) 10 (9.1) 20 (71.4) 8 (28.6) 55.1 (19–82) 4 (14.3) 16 (57.1) 8 (28.6) 10 (35.7) 14 (50) 3 (10.7) 1 (3.6) 14 (50.0) 14 (50.0) 21 (75.0) 7 (25.0) 23 (82.1) 5 (17.9) 19.6 (1–71) 23 (82.1) 5 (17.9) 53 P value 0.106 0.025 0.012 0.307 0.667 0.562 0.130 0.611 0.183 and malignant diseases were included. Nevertheless, this analysis reflects the quality of defunctioning ileostomy closure in an academic tertiary referral center. A defunctioning stoma decreases the clinical leak rate and reoperation rate and is therefore recommended after low anterior resection and restorative proctocolectomy with IPAA [1, 3]. Unfortunately, randomized trials on the clinical impact of defunctioning ileostomy choose anastomotic leakage as primary endpoint, and complications after stoma closure are often not included in the overall analysis [17]. Furthermore, ileostomy closure is not counted as a reoperation in these trials, because it was a planned procedure. This is questionable given its clinical impact and associated cost. The currently available data cannot provide clear guidelines regarding which anastomosis should be pri- marily diverted based on the overall complication rate. Of course, several risk factors for anastomotic leakage have been identified, but the complications related to stoma closure are not properly weighed against the reduced leakage rate [2, 18]. The present study suggests that selective use of a defunctioning ileostomy after low rectal or anal anastomosis is justified. If there is any sign of leakage of the undiverted anastomosis in the early postoperative course, a secondary defunctioning ileostomy can be constructed in the acute setting. These stomas have a high closure rate and are not associated with an increased complication rate as is demonstrated by our analysis. Further studies should focus on selection criteria by which an optimal balance between advantages and disadvantages of primary diversion can be achieved. In conclusion, closure of a defunctioning ileostomy is associated with 20% morbidity and a reoperation rate of 8%. The only risk factor after multivariate analysis for a complicated course was ASA score, but no impact could be demonstrated for type of anastomosis or the acute setting. Based upon these results, a secondary ileostomy for the treatment of anastomotic complications seems to be a valid option. The significant morbidity of stoma closure appeals for a combined endpoint including these complications in further studies on defunctioning ileostomies. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per- mits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.