{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:59:36Z","timestamp":1785142776237,"version":"3.55.0"},"reference-count":45,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Protective ileostomy (PI) after low anterior resection may not prevent anastomotic leakage (AL) but may lessen its clinical consequences, while adding stoma-related morbidity. This study evaluated the association of PI with the clinical course of AL and stoma-related outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients who underwent total mesorectal excision with low anterior resection after neoadjuvant therapy were retrospectively reviewed and grouped as LAR alone (n = 10) or LAR + PI (n = 74). Main outcomes were AL severity, management, leak-related mortality, AL incidence, and PI-related morbidity, including closure outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 84 patients, AL occurred in 5.9% (5\/84), without a significant difference (LAR 10.0% vs LAR + PI 5.4%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.478). Reoperation was required in one LAR patient and two PI patients; two PI patients were managed with percutaneous drainage. Leak-related mortality occurred in one LAR patient and none in the PI group. Length of stay was longer with PI (median 10.0 days, interquartile range [IQR] 9.0-11.0) than without PI (7.5\u00a0days, IQR 6.0-8.0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Protective ileostomy-related complications included outlet obstruction (9.5%), surgical site infection (4.1%), bleeding (4.1%), and parastomal hernia (2.7%). Closure was achieved in 90.5% after a median of 180\u00a0days (IQR 142.5-273); post-closure complications included obstruction (9.2%), infection (4.6%), small-bowel leak (4.6%), and bleeding (1.5%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Protective ileostomy was not associated with a statistically significant reduction in anastomotic leakage incidence but appeared to be associated with a more favorable clinical course when leakage occurred, including lower mortality and the feasibility of less invasive management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261471475","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T02:43:23Z","timestamp":1784947403000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Protective Ileostomy After Low Anterior Resection for Rectal Cancer: Modifying the Clinical Course of Anastomotic Leakage at the Cost of Stoma-Related Morbidity"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5455-3258","authenticated-orcid":false,"given":"Mustafa","family":"Y\u0131lmaz","sequence":"first","affiliation":[{"name":"Mersin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9313-9372","authenticated-orcid":false,"given":"Mahsum","family":"Bar\u00e7in","sequence":"additional","affiliation":[{"name":"Mersin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cumhur","family":"\u00d6zcan","sequence":"additional","affiliation":[{"name":"Mersin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U\u011ffe Kuyucuo\u011flu","family":"\u00d6zkan","sequence":"additional","affiliation":[{"name":"Mersin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00fcseyin O\u011fuzhan","family":"\u0130nan","sequence":"additional","affiliation":[{"name":"Gaziantep City Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0389-0523","authenticated-orcid":false,"given":"Hilmi","family":"Bozkurt","sequence":"additional","affiliation":[{"name":"Mersin University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahsin","family":"\u00c7olak","sequence":"additional","affiliation":[{"name":"Mersin University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21772"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01208"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2025.01.006"},{"key":"e_1_3_6_5_2","first-page":"67","article-title":"Rectal cancer surgery: what's in a name?","volume":"82","author":"Komen N","year":"2019","unstructured":"Komen N, Dewint P, Van den Broeck S, Pauli S, de Schepper H. 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