Int J Colorectal Dis (2012) 27:49–54 DOI 10.1007/s00384-011-1276-7 ORIGINAL ARTICLE Morbidity related to defunctioning ileostomy closure after ileal pouch-anal anastomosis and low colonic anastomosis Henderik L. van Westreenen & Annelies Visser & Pieter J. Tanis & Willem A. Bemelman Accepted: 28 June 2011 / Published online: 15 July 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com Abstract Purpose Defunctioning ileostomies are widely performed in order to prevent or treat anastomotic leakage after colorectal surgery. The aim of the present study was to determine morbidity related to stoma closure and to identify predictive factors of a complicated postoperative course. Methods A consecutive series of 138 patients were retro- spectively analyzed after stoma reversal. Data collection included general demographics and surgery-related aspects. Morbidity related to stoma closure was retrieved from our prospectively collected registry of complications. Results In 74 of 138 patients, defunctioning ileostomy was performed after restorative proctocolectomy and ileal pouch- anal anastomosis (IPAA). The remaining ileostomies (n=64) were constructed after a low colorectal or coloanal anastomo- sis. A total of 46 complications were recorded in 28 patients resulting in an overall complication rate of 20.3%. Anasto- motic leakage rate was 4.3%, and reoperation rate was 8.0%. The number of complications according to the Clavien–Dindo classification was 5 for grade I (10.9%), 26 for grade II (56.5%), 13 for grade III (28.3%), 1 for grade IV (2.2%), and 1 for grade V (2.2%). Multivariate analysis revealed a signifi- cantly higher ASA score in the complicated group (P= 0.015, odds ratio 2.6, 95% confidence interval 1.2–5.6). Conclusions Closure of a defunctioning ileostomy is associ- ated with 20% morbidity and a reoperation rate of 8%. There H. L. van Westreenen (*) : A. Visser : P. J. Tanis : W. A. Bemelman Department of Surgery, Academic Medical Center, Postbox 22660, 1100 DD Amsterdam, The Netherlands e-mail: e.van.westreenen@antoniusziekenhuis.nl H. L. van Westreenen Department of Surgery, St. Antoniusziekenhuis, Postbox 2500, 3430 EM Nieuwegein, The Netherlands is an urgent need for criteria on which a more selective use of a defunctioning ileostomy after low colonic anastomosis or IPAA can be based given its associated morbidity. Keywords Defunctioning ileostomy . Stoma . Ileostomy . Morbidity Introduction Defunctioning ileostomies are widely performed in order to prevent anastomotic leakage after colorectal surgery, especially anterior resection and restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) [1, 2]. A recent meta-analysis demonstrated a reduction of clinical anastomotic leakage rate after a defunctioning stoma leading to a reduction in the number of reoperations, but without significant decrease of mortality [3]. Besides, primary defunctioning loop ileosto- mies are constructed as treatment of anastomotic-related complications in the acute postoperative setting. Although the potential benefits of an ileostomy are clear, the loop ileostomy itself is associated with significant morbidity affecting patients’ daily activities. Stoma-related complications like prolapse, parastomal hernia, retraction, and high output occur in up to 30% of patients with a stoma [4, 5]. In addition, stoma reversal is accompanied with substantial morbidity (20%) which should be taken into account at the time of creation of a prophylactic stoma [6]. Most defunctioning stomas are for temporary fecal diver- sion, but a complicated clinical course following the initial colorectal operation is a limiting factor for stoma reversal resulting in a permanent stoma [7]. This retrospective study was performed to identify risk factors for complications after reversal of a defunctioning stoma to divert a low colonic anastomosis or IPAA.