Should a Contrast Enema Be Performed Before Reversal of a Diverting Stoma in Lower Rectal Surgery?

A defunctioning loop ileostomy is often used to reduce the conse-quences of anastomotic leakage, especially in a low rectal anasto-mosis. Hanna et al. [1] showed that fecal diversion could be rec-ommended as a selective tool to protect or ameliorate an anasto-motic leak after a colorectal anastomosis. Tan et al. [2] also argued that the creation of diverting stomas could potentially minimize the fatal outcomes of anastomotic leakage, although it might not substantially decrease the incidence of anastomotic leakage in rec-tal cancer surgery. However, some authors reported that a divert-ing stoma did not have a significant relationship with symptom-atic anastomotic leakage before and after their propensity score matching [3]. Another study also argued that a diverting stoma did not affect postoperative morbidity in a large cohort of patients undergoing low rectal anastomosis and that the routine use of a diverting stoma could rather delay postoperative recovery [4]