Every surgeon has faced the intraoperative dilemma of whether to divert. In some cases, the decision appears obvious: an ultralow anastomosis, questionable tension, heavy pretreatment with corticosteroids or chemotherapy, or nutritional compromise.
However, most of the time it is a “judgment call” with real, but not overwhelming, risk at the anastomosis. Such judgment is often heavily influenced by a surgeon's recent experience (eg, the anastomosis that looked perfect, was tension free and well vascularized, and had no air leak on insufflation testing but leaked anyway). This type of experience might lead us to use the “safe” option of ileostomy more often.