***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Closure of ileostomy is considered a contaminated operation . The infection rate of the stoma wound is ≥30 % . Several ileostomy – closure techniques intended to reduce the high rate of infection have been described in the literature . Among them , delayed primary closure of the stoma wound is a commonly used method that was reported to reduce the infection rate according to several retrospective studies . We therefore conducted the first prospect i ve r and omized trial comparing primary with delayed primary closure of a stoma wound . Methods During 2003 , 40 patients were admitted to our ward for closure of ileostomy .  The ileostomies were taken down by the same team using the same surgical technique except for the technique of wound closure . We r and omly divided the patients into two groups . In Group 1 ( n = 20 ) , the wound was left open for delayed primary closure and not closed until postoperative day 4 . In Group 2 , the wound was primarily closed at the end of the procedure . Results The total wound infection rate was relatively low ( 15 % ) . Infection occurred more frequently ( 4 cases , 20 % ) in Group 1 than in Group 2 ( 2 cases , 10 % ) . The length of hospital stay was similar for both groups . Conclusions In this first prospect i ve comparison of two techniques during ileostomy take down , primary closure unexpectedly produced less wound infection than delayed primary closure BACKGROUND Postoperative chemoradiotherapy is the recommended st and ard therapy for patients with locally advanced rectal cancer . In recent years , encouraging results with preoperative radiotherapy have been reported . We compared preoperative chemoradiotherapy with postoperative chemoradiotherapy for locally advanced rectal cancer . METHODS We r and omly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either  preoperative or postoperative chemoradiotherapy . The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day , five days per week , and fluorouracil , given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy . Surgery was performed six weeks after the completion of chemoradiotherapy . One month after surgery , four five-day cycles of fluorouracil ( 500 mg per square meter per day ) were given . Chemoradiotherapy was identical in the postoperative-treatment group , except for the delivery of a boost of 540 cGy . The primary end point was overall survival . RESULTS Four hundred twenty-one patients were r and omly assigned to receive preoperative chemoradiotherapy  and 402 patients to receive postoperative chemoradiotherapy . The overall five-year survival rates were 76 percent and 74 percent , respectively ( P=0.80 ) . The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative chemoradiotherapy and 13 percent in the postoperative-treatment group ( P=0.006 ) . Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group , as compared with 40 percent of the patients in the postoperative-treatment group ( P=0.001 ) ; the corresponding rates of long-term toxic effects were 14 percent and 24 percent , respectively ( P=0.01 ) . CONCLUSIONS Preoperative chemoradiotherapy , as compared with postoperative chemoradiotherapy , improved local control and was associated with reduced toxicity but did not improve overall survival Purpose Low anterior resection has become the operation of choice for mid rectal or low rectal cancer . A defunctioning stoma is routinely created at some centers to decrease the risk of leakage requiring surgical intervention . This study was design ed to evaluate the quality of life in patients undergoing low anterior resection with a temporary ileostomy .  Methods A prospect i ve longitudinal study was conducted in 22 patients with rectal cancer who underwent low anterior resection with a loop ileostomy .  Quality of life was assessed by using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 question naires . Twenty-five patients who underwent high anterior resection for rectosigmoid cancer were studied concurrently to evaluate the impact of major colorectal resection without a stoma . Results Patients ’ scores on the quality of life question naires generally improved after high anterior resection ; however , for patients who underwent low anterior resection , the scores for physical and role functioning before ileostomy closure were worse than the preoperative values . The scores on the quality of life question naires generally improved after ileostomy closure . Ileostomy closure required a short hospital stay and was rarely associated with complications . Conclusion Patients who underwent low anterior resection with ileostomy had significant reductions in physical and role functioning , which apparently improved after ileostomy closure . Similar declines in these quality of life variables were not found in patients who underwent high anterior resection . A temporary ileostomy should be created in selected patients with the highest risk of anastomotic leakage . Increased re sources for not only surgical care but also for stoma therapy are necessary for patients who undergo low anterior resection with a temporary ileostomy BACKGROUND / AIMS Temporary loop ileostomies constructed to protect distal anastomoses are generally closed at 8 to 12 weeks , a period long enough to encounter stoma-related complications , which reduces the quality of life . Early closure may be considered to overcome these adverse effects . This prospect i ve study was design ed to investigate the reliability of early closure of loop ileostomies . METHODOLOGY Fifty consecutive patients were sequentially distributed either to group A ( delayed closure ) or group B ( early closure ) .  Anastomotic integrity  was examined before closure in all patients . RESULTS There were 25 patients in each group who were comparable in terms of age , sex , comorbid conditions , primary pathology , and tumor stage .  Early closure was achieved in 88 % ( n=22 ) of the patients in group B. Stoma-related complications were significantly greater in group A patients ( 44 % vs. 16 % ) ( p<0.05 ) while the complications following closure were similar in both groups ( 16 % vs. 8 % ) ( p>0.05 ) . CONCLUSIONS Early closure during the same hospital admission produces less stoma-related complications with similar accomplishment as the late closure . Early closure of temporary ileostomy is recommended in suitable patients without anastomotic complications The impact of anastomotic leakage on long-term outcomes after curative surgery  for colorectal cancer has not been well documented . This study aim ed to investigate the effect of anastomotic leakage on survival and tumor recurrence in patients who underwent curative resection for colorectal cancer . Prospect ively collected data of the 1,580 patients ( 904 men ) of a median age of 70 years ( range : 24–94 ) , who underwent potentially curative resection for colorectal cancer between 1996 and 2004 , were review ed . Cancer-specific survival and disease recurrence were analyzed using Kaplan Meier method , and variables were compared with log rank test . Cox regression model was used in multivariate analysis . The cancer was situated in the colon and the rectum in 933 and 647 patients , respectively .  Anastomotic leakage  occurred in 60 patients ( clinical leakage : n = 48 ; radiological leak : n = 12 ) . The leakage rate was significantly higher in patients with surgery for rectal cancer ( 6.3 vs 2.0 % , p < 0.001 ) . The 5-year cancer-specific survivals were 56.9 % in those with leakage and 75.9 % in those without leakage ( p = 0.012 ) . The 5-year systemic recurrence rates were 48.4 and 22.6 % in patients with and without anastomotic leak , respectively ( p = 0.001 ) , whereas the 5-year local recurrence rates were 12.9 and 5.7 % , respectively ( p = 0.009 ) .  Anastomotic leakage  remained an independent factor associated with a worse cancer-specific survival ( p = 0.043 , hazard ratio : 1.63 , 95 % CI : 1.02–2.60 ) and a higher systemic recurrence rate ( hazard ratio : 1.94 , 95 % CI : 1.23–3.06 , p = 0.004 ) on multivariate analysis . In rectal cancer ,  anastomotic leakage  was an independent factor for a higher local recurrence rate ( hazard ratio : 2.55 , 95 % CI : 1.07–6.06 , p = 0.034 ) . In conclusion ,  anastomotic leakage is associated with a poor survival and a higher tumor recurrence rate after curative resection of colorectal cancer . Efforts should be undertaken to avoid this complication to improve the long-term outcome BACKGROUND Defunctioning loop ileostomies are uncommonly used forms of fecal diversion . The aim of this study was to determine the morbidity associated with both construction and reversal of loop ileostomies . STUDY DESIGN An analysis was performed of all patients who underwent loop ileostomy construction or reversal between 1990 and 1997 , with data being collected prospect ively . RESULTS One-hundred-two patients , ( 43 male , 59 female ) with a mean age of 38 years ( range 13 to 81 years ) had loop ileostomies constructed . Indications for ileostomy construction included inflammatory bowel disease ( 76 patients ) , ultralow anterior resection for carcinoma ( 16 patients ) , or miscellaneous reasons ( 10 patients ) . Nine patients ( 9 % ) had complications arising from ileostomy construction including 4 parastomal infections , 3 high output ileostomies , 1 small-bowel obstruction , and 1 ileostomy stenosis in the early postoperative period . Only the stricture required surgical intervention . All other complications improved with conservative management . Mean time to ileostomy reversal was 120 days . Three patients ( 4 % ) had complications associated with reversal . All of these complications required surgical intervention , 2 for small bowel obstruction , and 1 for small bowel perforation . Currently 84 patients have had their ileostomy reversed , and 12 patients have had their loop ileostomy converted to a permanent stoma for reasons not related to the loop ileostomy itself . CONCLUSIONS Defunctioning loop ileostomy is associated with low morbidity . We recommend a defunctioning ileostomy as the procedure of choice for temporary fecal diversion Purpose A loop ileostomy is constructed to protect a distal anastomosis , and closure is usually performed not earlier than after two to three months . Earlier closure might reduce stoma-related morbidity , improve quality of life , and still effectively protect the distal anastomosis . This pilot study was design ed to investigate the feasibility of early closure of loop ileostomies , i.e. , during the same hospital admission as the initial operation . METHODS : Twenty-seven consecutive patients with a protective loop ileostomy were included . If patient ’s recovery was uneventful , water-soluble contrast enema examination was performed , preferably after seven to eight days . If no radiologie signs of leakage were detected , the ileostomy was closed during the same hospital admission . RESULTS : Twenty-seven patients ( 8 females ; mean age , 60 years ) were analyzed . Eighteen patients had early ileostomy closure on average 11 ( range , 7 - 21 ) days after the initial procedure . In nine patients the procedure was postponed because of leakage of the anastomosis ( n = 3 ) , delayed recovery ( n = 1 ) , small bowel obstruction ( n = 1 ) , gastroparesis ( n = 1 ) , logistic reasons ( n = 2 ) , or irradical cancer resection followed by radiotherapy ( n = 1 ) . There was no mortality and four mild complications occurred after early closure : superficial wound infection ( n = 2 ) , intravenous-catheter sepsis ( n = 1 ) , small bowel obstruction ( n = 1 ) . CONCLUSION : Closure of a loop ileostomy early after the initial operation was feasible in 18 of 27 patients and was associated with low morbidity and no mortality Patients undergoing colorectal surgery who required a defunctioning stoma were r and omly allocated to receive either a loop ileostomy ( n = 23 )  or transverse loop colostomy ( n = 24 ) . Assessment was made during construction , immediately postoperatively , during the period of outpatient supervision and before and after stoma closure . The ileostomy was associated with significantly less odour than the colostomy ( P<0.01 ) and required significantly less appliance changes ( P<0.05 ) . Furthermore eleven patients ( 58 per cent ) with a colostomy experienced three or more problems with stoma management compared with only three patients ( 18 per cent ) with an ileostomy ( P<0.05 ) . Wound infection was also significantly more common after closure of the colostomy compared with the ileostomy . Both types of stoma were demonstrated objective ly to defunction the distal bowel almost completely . These results indicate that a loop ileostomy is the procedure of first choice when a stoma is needed to defunction the distal colorectum Abstract . Low anterior resection with total mesorectal excision for rectal carcinoma is associated with a high anastomotic leakage rate , and the effectiveness of a defunctioning stoma in preventing anastomotic leakage remains controversial . In this study a policy of selective defunctioning stoma for stapled colorectal anastomosis after low anterior resection with total mesorectal exc 
    Output:
    
Conclusion The consequences of anastomotic leakage following colorectal resection are severe .
However , the consequences of stoma reversal are often underestimated .
In this way , patients at low risk may be spared the morbidity of stoma reversal