Does timing of ileostomy closure impact postoperative morbidity?

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Colorectal Surgery

Background:

• Diverting loop ileostomy (DLI) reversal is typically performed at 12 weeks or later.
• Early closure aims to reduce DLI-associated morbidity.
• The impact of timing on postoperative outcomes after DLI reversal requires further investigation.

Purpose of the Study:

• To determine if the time to stoma reversal influences postoperative morbidity following DLI closure.
• To evaluate the safety and efficacy of early DLI reversal.

Main Methods:

• Retrospective review of American College of Surgeons National Surgical Quality Improvement Program data (2012-2021).
• Analysis of adult patients undergoing DLI closure, stratified by time to reversal: ≤12 weeks, 12-24 weeks, and 24-36 weeks.
• Primary outcome: major morbidity after DLI closure.

Main Results:

• 482 patients underwent DLI closure; 17.4% were closed ≤12 weeks.
• No significant differences in major morbidity, complication severity, anastomotic leaks, or need for laparotomy were observed across closure time groups.
• Immunosuppressive therapy and low preoperative hematocrit (<30%) were identified as risk factors for major morbidity.

Conclusions:

• Major morbidity rates are comparable regardless of the timing of DLI closure.
• Closure of DLI at ≤12 weeks is a safe option for carefully selected patients.
• Further research may explore specific patient selection criteria for early stoma reversal.