The complexity of IPAA and the seriousness of the functional consequences of pelvic sepsis from anastomotic dehiscence justify the almost routine adoption of the protective ileostomy . Ileostomy does not completely eliminate the risk of pelvic sepsis, but it mitigates its negative consequences and facilitates its treatment [24, 25] even if at the price of a 10-30% of complications connected with its construction and closure [24, 27]. Even if several trials suggest the possibility of performing one-stage IPAA with overlapping pelvic complications, minor occlusive episodes and a shorter hospitalisation [28, 29], in other authors' experience [30-32], omission of the ileostomy is connected with an increase of anasto-motic complications and pelvic sepsis. Despite an aggressive therapeutic attitude, the risk of reservoir failure in patients with septic complications is 31% after 5 years and 39% after 10 years since surgery . In the light of these data, one-stage IPAA may be offered if the surgeon is an expert and in selected low-risk cases (patients with a suitable nutritional status, not undergoing immunosuppressive therapy, under treatment with a low steroid dosage) where the operation follows an ideal course without any technical incidents or problems of anastomotic tension [24, 30, 33]. However, it is noteworthy that the results of a recent experience investigating the reasons for long-term failure of RPC be taken into account, which demonstrate the omission of protective ileostomy as one major adverse prognostic factor .
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