Anastomotic leakage (AL) remains the most serious and feared complication following colorectal anastomosis, with reported incidence rates ranging from 6% to 30% despite advances in surgical techniques and perioperative care. Preventive ileostomy is frequently employed to mitigate the consequences of AL; however, its routine use continues to be debated due to associated morbidity and impact on patient quality of life. The present study aimed to evaluate the role of preventive ileostomy in promoting primary healing of colorectal anastomoses and in reducing both the incidence and severity of AL.

A retrospective cohort study was conducted at ATU TCK between 2020 and 2025, including 140 patients who underwent colon resection with colorectal anastomosis. Among these, 52 patients received a preventive ileostomy (Group I), while 88 patients did not (Group II). Clinical assessment, laboratory parameters including leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin (PCT), along with radiological investigations such as computed tomography and ultrasonography, were used for early diagnosis of AL.

Anastomotic leakage occurred in 11 patients (7.85%), with a lower incidence observed in the ileostomy group (5.76%) compared to the non-ileostomy group (9.09%). The majority of leaks were classified as Grade C, indicating severe clinical presentation. Reoperation was required in all patients without ileostomy who developed AL and in 87.5% of patients with ileostomy. Although operative duration was longer in the ileostomy group, postoperative recovery of bowel function and initiation of feeding occurred earlier.

Preventive ileostomy reduces the severity and clinical consequences of AL but does not eliminate its occurrence. Given the associated complications and impact on quality of life, routine use of ileostomy is not recommended, and individualized decision-making based on patient-specific risk factors is essential.