Role of Distal loopogram Before Defunctioning Stoma Reversal-

Radical surgery with total or partial tumor-specific mesorectal excision remains the mainstay of treatment for rectal cancers. Development of the anastomotic leakage is the most feared postoperative complication after rectal cancer surgery with incidence in the published literature ranging from 1.8 to 19.8% [1-2]. Advances in the management in the form of neoadjuvant chemoradiotherapy, staging with magnetic resonance imaging, availability of staplers, acceptance of lessextensive distal margins, and improved perioperative care have lead to increase in the number of low and ultralow anterior resections being performed all around the world. Literature suggests that presence of a defunctioning stoma decreases the incidence and the severity of anastomotic leakage and is recommended in all patients undergoing low anastomosis after proctectomy [3-4]. As a result, there has been a significant increase in the number of defunctioning stoma performed.It is well known that defunctioning stomas lead to inferior quality of life and causes major psychological handicap for the patient [5]. As a result, main aim while creating a stoma is to ensure its reversal at 6-12 weeks after the initial surgery. However, scheduling of reversal is extremely variable among various institutions [6]. Before stoma reversal, the distal anastomosis is routinely evaluated to rule out anastomotic leak or stricture by digital rectal examination, proctoscopy, and distal loopogram. This is important as postoperative morbidity ranging from 3 to 40% and mortality ranging from 0 to 4% after stoma reversal have been reported in literature [7-9].