Int J Colorectal Dis (2012) 27:49–54 Table 1 Baseline characteristics of 138 patients undergoing closure of a defunctioning stoma Characteristics Sex Male Female Age (years)a ASAb class I II III Diagnosis at initial surgery Ulcerative colitis Colorectal cancer Familial adenomatous polyposis Crohn’s disease Other Indication for defunctioning stoma Ileal pouch-anal anastomosis Low colorectal or coloanal anastomosis Setting of construction of defunctioning stoma Elective (prophylactic) Acute (anastomotic complications) Surgeon Resident Colorectal surgeon Anastomotic technique Hand-sewn Stapled Time to stoma closure (weeks)c Hospital stay (days)c a Mean (SD) b American Society of Anesthesiology c Median (range) Number (%) 80 (58.0) 58 (42.0) 49.3 (15.7) 31 (22.5) 90 (65.2) 17 (12.3) 62 (44.9) 51 (37) 10 (7.2) 5 (3.6) 10 (7.2) 74 (53.6) 64 (46.4) 109 (79) 29 (21) 124 (89.9) 14 (10.1) 123 (89.1) 15 (10.9) 16.9 (0.9–70.6) 5.0 (2–67) In three patients, stoma closure was performed simultaneously during liver resection for colorectal metastases. Twenty-eight patients (20.3%) had a complicated course, consisting of a total of 46 complications (Table 3). The anastomotic leakage rate was 4.3%. The Clavien–Dindo grade of complications was grade I in 10.9% (n = 5), grade II in 56.5% (n = 26), grade III in 28.3% (n = 13), grade IV in 2.2% (n = 1), and grade V in 2.2% (n = 1). Readmission rate within 30 days after stoma closure was 3.6% of the patients, predominantly for rehydration or treatment for small bowel obstruction. In one patient, stoma reversal was combined with dilatation of the colorectal anastomosis resulting in perforation requiring reoperation. Seventeen reoperations were performed in 11 patients (8.0%), and construction of an ileostomy was necessary again in eight patients (5.8%) 51 (Table 3). One patient had a massive bleeding from the epigastric artery leading to multiple organ failure and eventually death. This accounts for a mortality rate of 0.7%. To identify risk factors for the development of compli- cations after loop ileostomy closure, potentially related variables were compared between the group of 110 patients with an uncomplicated course and the group of 28 patients with a complicated course (Table 4). Univariable analysis revealed that the complicated group had a significant higher age and a higher ASA score in comparison to the group without complications. No significant association with a complicated postoperative course was found for gender, primary diagnosis, type of primary surgery, setting of stoma creation (elective versus acute), surgeon, time to stoma closure, or anastomotic technique. Multivariate analysis revealed a higher ASA score as the only predictor for a complicated course after stoma reversal (P= 0.015, odds ratio 2.6, 95% confidence interval 1.2–5.6). Discussion Loop ileostomy closure is accompanied by a substantial morbidity and even a small risk of mortality as demon- strated by the present study. This analysis comprised both electively and acutely created ileostomies, in contrast to previous studies which only focussed on the elective setting. The overall complication rate of 20% fits well within the morbidity rates as reported in the literature (11– 37%) [6, 8–10]. A reoperation was necessary in 8% which is higher as reported in a recent systematic review concerning stoma reversal [6]. However, this review reported a reoperation rate of 2.5% for small bowel obstruction only. Therefore, 8% of reoperations might be more realistic as they reflect the overall percentage for several postoperative complications as was demonstrated by Mansfield et al. [11]. Small bowel obstruction was the most frequent compli- cation (6.5%) and responsible for the majority of readmis- sions. Edema of a narrowed anastomosis may cause a small bowel obstruction in the postoperative period. Previous reports suggested that a stapled closure might prevent small bowel obstruction due to the larger bowel lumen that is created [12]. However, a recent meta-analysis did not demonstrate differences in clinical outcome between hand- sewn and stapled anastomosis after ileostomy closure [13]. Based upon our current findings, a liquid diet is provided until normal passage is established in order to avoid small bowel obstruction in the early postoperative phase. A difference in complication rate between the closure of a defunctioning ileostomy for a colorectal or coloanal anastomosis on the one hand and an IPAA on the other hand could not be demonstrated. Some authors have reported a