If one is constructing an ileal J-pouch anal anastomosis under tension, it is extremely important to always divert the patient no matter how difficult it appears that creation of the stoma will be. Imagine how miserable a situation it would be if the patient would have an anastomotic leak and required reoperation and diversion-it would be twice as difficult then. One must always optimize the conditions for successful anastomotic healing. If the anastomosis is created under tension, this includes diversion.
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