I think reducing the incidence of anastomotic leak is great. In my personal experience, having a leak is stressful and should be avoided, so I am a supporter of this movement.

I notice that a large component of the education is driven at decision making and choosing whether to do either anastomosis or end ileostomy and thus avoiding risk of leak altogether. So considering the potential results of this trial, if they were positive and did show that the overall leak rate had been reduced, the reader might ask, ‘well isn’t that just because we committed more people to a permanent stoma? If so, how many of those had their stoma formed unnecessarily?’. In other words, is it that this trial will simply shift the world to err more on the side of caution, and in doing so, overtreating a cohort with a stoma when luck was going to be on their side if they had had an anastomosis. I suspect this will be a difficult question to answer.