{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T06:22:48Z","timestamp":1776493368554,"version":"3.51.2"},"reference-count":25,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,7,7]],"date-time":"2019-07-07T00:00:00Z","timestamp":1562457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>In patients with a previous history of rectal anastomotic leakage (<jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content>), the surgical indications and timing for closure of a diverting stoma have to be carefully judged. Even if <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content> has apparently healed before stoma closure, re\u2010leakage may occur after closure. The aim of this study was to determine the incidence and risk factors for recurrent AL following stoma closure. We also examined the treatment strategies aiming to minimize the risk of recurrent AL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January 2009 to December 2016, 1008 patients underwent sphincter\u2010saving surgery [low anterior resection, all\u2010sphincter\u2010preserving rectal resection with hand\u2010sewn coloanal anastomosis (<jats:styled-content style=\"fixed-case\">CAA<\/jats:styled-content>) and intersphincteric resection (<jats:styled-content style=\"fixed-case\">ISR<\/jats:styled-content>)] for primary rectal cancer with curative intent at our hospital. A total of 69 patients with <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content> with a Clavien\u2013Dindo Grade <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> or more who subsequently underwent closure of a diverting stoma were retrospectively reviewed for this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of recurrent leakage after stoma closure in this series was 13% overall with an incidence of 25% in the <jats:styled-content style=\"fixed-case\">CAA<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">ISR<\/jats:styled-content> group and 5% in the low anterior resection group. Significant risk factors included hand\u2010sewn anastomosis (<jats:italic>P\u00a0=\u00a0<\/jats:italic>0.0257) compared to stapled anastomosis, ischaemia at the anastomotic site as the cause of initial <jats:styled-content style=\"fixed-case\">AL<\/jats:styled-content> (<jats:italic>P\u00a0&lt;\u00a0<\/jats:italic>0.001) and a shorter interval between confirmation of healing and stoma closure (<jats:italic>P\u00a0=\u00a0<\/jats:italic>0.00952).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Ischaemia at the anastomotic site was the main risk factor for recurrent leakage, particularly after <jats:styled-content style=\"fixed-case\">CAA<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">ISR<\/jats:styled-content>. Additional treatment options before stoma closure should be considered to avoid re\u2010leakage in such cases.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.14728","type":"journal-article","created":{"date-parts":[[2019,6,14]],"date-time":"2019-06-14T13:18:42Z","timestamp":1560518322000},"page":"1304-1311","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors"],"prefix":"10.1111","volume":"21","author":[{"given":"D.","family":"Kitaguchi","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery National Cancer Center Hospital East Kashiwanoha, Kashiwa Chiba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Nishizawa","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery National Cancer Center Hospital East Kashiwanoha, Kashiwa Chiba 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