50 Patients and methods From January 2004 to June 2010, 366 consecutive patients underwent elective colorectal surgery with primary rectal or anal anastomosis. All procedures were performed in the Academic Medical Center (AMC), a university hospital and tertiary referral center. Of the 366 patients, 204 patients underwent a proctocolectomy followed by IPAA, and the remaining 162 patients had an anterior resection or low anterior resection followed by a colorectal or coloanal anastomosis, respectively. A defunctioning stoma was created in 135 patients during the initial procedure. In an additional number of 32 patients, the primary operation had a complicated course, and a defunctioning stoma was created to treat anastomotic-related complications (Fig. 1). Of these 167 patients with a defunctioning stoma, closure was performed in 138 (82.6%), and these patients were included in our retrospective analysis. Patient data and surgery-related characteristics were retrospectively collected by retrieving medical records. Data collection included general demographics, primary diagnosis, indication for loop ileostomy, time from forma- tion to closure, and operative technique of stoma closure. Morbidity related to stoma closure was retrieved from our prospective collected registry of complications of the surgical department of the AMC. Closure of the loop ileostomy was mostly performed by a surgical resident under the direct supervision of a colorectal surgeon. The stoma was dissected from the mucocutaneous junction and delivered from the rectus sheath and peritoneal cavity by sharp dissection. The enterotomy was closed by a running suture or a stapled closure based upon the Fig. 1 Of the 167 patients with a defunctioning stoma, closure was performed in 138 Int J Colorectal Dis (2012) 27:49–54 preferences of the supervising surgeon. The posterior and anterior rectus sheaths were closed separately to minimize the risk of an incisional hernia. The wound was partially left open to prevent wound infection. Descriptive statistics were used for data analysis in presentation. Differences between groups were assessed for statistical significance (P < 0.05) using either chi-square test or Mann–Whitney U test when appropriate. Subsequently, a stepwise multivariate analysis was performed using a forward conditional model. Statistical analysis was per- formed using the SPSS software package (SPSS 16.0, Chicago, IL, USA). Results In total, 138 defunctioning ileostomies were closed over the study period and included in this retrospective analysis. The group consisted of 80 male and 58 female patients with a mean age at closure of 49 years (Table 1). The majority of patients (65%) had an American Society of Anesthesiology (ASA) score of 2. The predominantly primary diagnoses of the patients were ulcerative colitis and colorectal cancer. The setting for construction of an ileostomy was elective in 79% and acute in 21% of the patients. Comparing these two groups of patients revealed that the acutely created stomas were closed significantly later (Table 2). Furthermore, these patients were predominantly operated on for inflammatory bowel disease. Almost all stomas were closed by a surgical resident under the supervision of a colorectal surgeon, mostly using a hand-sewn technique (Table 1). The median time interval between construction and stoma closure was 17 weeks. Elective colorectal surgery (ileal pouch-anal anastomosis n=204) (low colorectal anastomosis n=162) N=366 Phrophylactic defunctioning stoma N=135 (36.9%) Stoma closure N=109 (80.7%) Defunctioning stoma for treatment of anastomotic leakage N=32 (8.7%) Stoma closure N=29 (90.6%)