***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: The results of the pelvic pouch procedure were review ed to assess the surgical complication rate and outcome of patients who had had the procedure performed with a stapled ileo-anal anastomosis with and without a defunctioning ilcostomy . Between December 1982 and March 1992 , 483 patients underwent a pelvic pouch ( PP ) procedure .  Patients were divided into three groups : group I consisted of 325 patients ( 178 men and boys and 147 women and girls ) who underwent a PP procedure with a h and sewn ileoanal anastomosis ( IAA ) with a defunctioning loop ileostomy .  In group II , there were 87 patients ( 47 men and boys and 40 women and girls ) who had a stapled IAA with a defunctioning ileostomy . Group III patients consisted of 71 patients ( 43 men and boys and 28 women and girls ) who had a stapled IAA with no covering ileostomy . Assessment was made of the IAA leak rate , the surgical complications , the reoperation rate , and functional outcome . Early surgical complications included 40 ( 12 % ) IAA leaks in group I patients compared with only six ( 7 % ) leaks in group II patients who had a stapled IAA ( p < 0.05 ) . In group III patients , who had a stapled IAA but no covering ileostomy , there were 13 leaks ( 18 % ) . Eleven of these 13 leaks healed spontaneously with tube drainage ; one patient remains with a rectal tube in place 6 weeks after operation , and only one patient has required a reoperation ( defunctioning ileostomy ) . Functionally , all patients with a healed IAA after a leak have had an excellent result comparable to those without a leak . Patients who were male , older than age 40 , on steroids , and had had a true one-stage PP procedure , had a greater risk of developing an IAA leak . In two patients , there was intraoperative difficulty , and one of these patients had an IAA leak after operation . Disease activity at the resection margin and patient weight did not affect the leak rate . Our results suggest that the IAA leak rate is significantly reduced in patients with a stapled IAA with an ileostomy compared with those with a h and sewn IAA . Omission of the defunctioning ileostomy is associated with a higher IAA leak rate , but spontaneous healing occurs in almost all patients without impairment of functional results . In patients in whom the ileostomy is omitted , the IAA leak rate is greatest in male patients who have undergone a true one-stage PP procedure , are on steroids , and are older than age 40 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 retrospectively analyzed after stoma reversal . Data collection included general demographics and surgery-related aspects . Morbidity related to stoma closure was retrieved from our prospect ively 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 anastomosis . A total of 46 complications were recorded in 28 patients result ing in an overall complication rate of 20.3 % . Anastomotic 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 significantly 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 associated with 20 % morbidity and a reoperation rate of 8 % . There 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 Purpose This study analyzes the impact of a temporary loop ileostomy on postoperative outcome after restorative proctocolectomy for ulcerative colitis in terms of complications and reoperations including ileostomy closure . Methods The records of 122 consecutive patients undergoing restorative proctocolectomy for ulcerative colitis during a 12-year period were review ed . In 89 patients , a defunctioning ileostomy was created , while 33 patients had no ileostomy .  Statistics were done with Chi-square test and Mann – Whitney U test , p < 0.05 considered significant . Results Both study groups were comparable concerning age , colitis activity , previous diseases , previous surgery , use of steroids , and immunosuppressives . Pouch-related septic complications ( anastomotic dehiscence , pouch leakage , pelvic abscess ) were significantly lower in the ileostomy group ( 5.6 % vs. 18.2 % , p = 0.031 ) , result ing in a lower rate of emergency laparotomies following restorative proctocolectomy ( 4.5 % vs. 30.3 % , p < 0.001 ) . Including all complications associated with scheduled closure of ileostomy , the cumulative frequency of emergency laparotomies was significantly lower in the ileostomy group ( 13.5 % vs. 30.3 % , p = 0.032 ) . The cumulative duration of hospitalization , including all hospital stays for complications or closure of the ileostomy , was significantly longer in the ileostomy group [ median 22 days ( 11–92 ) vs. 14 days ( 9–109 ) , p < 0.001 ] . During long-term follow-up , a stricture at the pouch-anal anastomosis was more common in the ileostomy group ( 24.7 % vs. 6.1 % , p = 0.021 ) , whereas only one stricture necessitated surgical therapy . Conclusions Creation of a defunctioning loop ileostomy reduces pouch-related septic complications and the frequency of emergency second laparotomies after restorative proctocolectomy for ulcerative colitis Purpose Controversy exists regarding the safety for omission of diverting ileostomy in restorative proctocolectomy because of fears of increased septic complications . This study was design ed to evaluate the outcomes of restorative proctocolectomy in a consecutive series of patients by comparing postoperative complications , functional results , and quality of life in patients with and without diverting ileostomy . Methods Data regarding demographics , length of stay , surgical characteristics , and complications were review ed and recorded according to the presence ( n= 1,725 ) or absence ( n = 277 ) of a diverting ileostomy at the time of pelvic pouch surgery . Criteria for omission of ileostomy included : stapled anastomosis , tension-free anastomosis , intact tissue rings , good hemostasis , absence of airleaks , malnutrition , toxicity , anemia , and prolonged consumption of steroids . Functional outcome and quality of lifeindicators were prospect ively recorded and compared . Results Patients in the ileostomy group had greater body surface area and older mean age at time of surgery , were taking greater doses of steroids preoperatively , and required more blood transfusions at the time of surgery compared with the one-stage ( P < 0.05 ) . There were no differences between the two groups in septic complications ( P > 0.05 ) . Early postoperative ileus was more common in the one-stage group ( P < 0.001 ) . There were no differences between the groups in quality of life and functional outcomes . Conclusions For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis , omission of diverting ileostomy is a safe procedure that does not lead to an increase inseptic complications or mortality . Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion , provided that certain selection factors are considered Background : Ileal pouch anal anastomosis ( IPAA ) is the treatment of choice for chronic , medically refractory mucosal ulcerative colitis , indeterminate colitis , familial adenomatous polyposis ( FAP ) , and a select group of patients with Crohn 's disease . Aim : We report outcomes , complications , and quality of life ( QOL ) in a cohort of 3707 patients treated at our institution from January 1984 to March 2010 . Methods : Data were collected from a prospect ively maintained data base and chart review of 3707 consecutive primary IPAA cases .  Patient demographics , postoperative complications , functional outcomes , and QOL data were available . Follow-up consisted of clinical examination with assessment of pouch function and QOL . Results : A total of 3707 patients underwent primary pouch and 328 underwent redo pouch surgery .  Postoperative histopathological diagnoses were mucosal ulcerative colitis ( n = 2953 , 79.7 % ) , indeterminate colitis ( n = 63 , 1.7 % ) , FAP ( n = 223 , 6 % ) , Crohn 's disease ( n = 150 , 4 % ) , cancer/dysplasia ( n = 97 , 2.6 % ) , and others ( n = 221 , 6.0 % ) . Early perioperative complications were encountered in 33.5 % of patients with a mortality rate of 0.1 % . Excluding pouchitis , late complications were experienced by 29.1 % of patients . Of those patients who had IPAA at our institution , pouch failure occurred in 197 patients ( 5.3 % ) . During a median follow-up of 84 months , 119 patients ( 3.2 % ) required excision of the pouch , 32 ( 0.8 % ) had a nonfunctioning pouch , and 46 patients ( 1.2 % ) had redo IPAA . Functional outcomes and QOL were good or excellent in 95 % of patients and similar in each histopathological subgroup . Conclusions : IPAA is an excellent option for patients with MUC , IC , FAP , and select patients with Crohn 's disease Restorative proctocolectomy and ileal pouch‐anal anastomosis  ( IPAA ) has been carried out on 88 patients since 1982 .  Three different pouch design s ( J , S and W ) were used . Ten pouches had to be removed . Detailed analysis was performed on 61 patients ( J = 23 , S = 15 , W = 23 ) whose pouches had been functioning for at least 6 months . There was no significant difference in surgical complications before or after ileostomy closure between pouch design s but the hospital stay was greater after construction of an S pouch ( P<0.05 ) . There were no significant differences in stool frequency , degree of continence or urgency between the three types . Twelve patients with J pouches required antidiarrhoeal medication compared with only one with S and five with W pouches . Only seven patients with S pouches could defaecate spontaneously compared with 22 with W pouches and all patients with J pouches ( P<0.001 ) . Twenty‐five of 29 patients who had preservation of the anal transition zone had perfect continence compared with 23 of 32 with a mucosal proctectomy ( P = n.s . ) . Pouchitis occurred in 13 patients , all of whom had ulcerative colitis . In a subgroup of 23 patients , pouch evacuation was assessed scintigraphically . There was no difference in pouch capacity or total volume evacuated , but spontaneous evacuation was better in J and W pouches compared with S pouches Objective : Few studies have evaluated factors that may be associated with the development of septic complications after  restorative proctocolectomy . Therefore , the aim of this study is to evaluate preoperative and operative factors that might be associated with septic complications after restorative proctocolectomy . Methods : Patients developing abdominal and pelvic septic complications after restorative proctocolectomy were identified from a prospect i ve data base . Patients with sub clinical leaks and ileostomy closure leak were not included in the septic complication group . A multivariable logistic regression model for sepsis was constructed using a forward stepwise selection with entry criterion of P < 0.05 . Results : From 1983 to 2007 , 3233 patients ( 56 % male ) were included in the data base . Eight-four percent ( 2597 ) of patients underwent proximal diversion .  Two hundred patients ( 6.2 % ) developed septic complications within 3 months of restorative proctocolectomy or within 3 months of ileostomy closure . On multivariate analysis , body mass index > 30 ( P = 0.02 , OR = 1.77 ) , final pathologic diagnosis of ulcerative/indeterminate colitis ( P = 0.02 , OR = 2 ) or Crohn 's disease ( P = 0.02 , OR = 3.6 ) , intraoperative ( P = 0.02 , OR = 1.6 ) , and postoperative transfusions ( P = 0.01 , OR = 1.9 ) were all independently associated with septic complications 
    Output:
    
Conclusion The considerable morbidity of ileostomy reversal reduces the overall benefit of temporary fecal diversion .
However , ileostomy creation is still recommended , as it effectively reduces the risk of pouch-related septic complications