Early Versus Late Ileostomy Closure After Anterior Rectal Resection: Association With Postoperative Complications

Protective ileostomy is often performed following anterior resection for rectal cancer to minimize the clinical consequences of anastomotic leakage. The actual operation to create the stoma is usually straightforward, although ileostomy management can result in considerable patient morbidity. The timing of ileostomy closure continues to be a subject of debate. While early closure of the stoma may alleviate an individual's experience of prolonged skin irritation or persistent concerns regarding hydration, it still raises concerns about postoperative safety.

We performed a retrospective, single-center study, analyzing patients who had anterior rectal resection (ARR) with a protective ileostomy between January 2016 and December 2023. From the electronic records, we collected clinical data, oncologic characteristics, operative notes, ileostomy closure data, and any postoperative complications (graded by Clavien-Dindo). For analysis, patients were divided into two groups: early closure (≤30 days) and late closure (>30 days). A multivariable model was used to evaluate factors associated with postoperative complications.  Results: Our cohort included 85 patients, with a mean age of 61.9 ± 11.1 years and a male predominance. The timing of ileostomy closure varied across the patients, with a median of 60 days. Around 24 patients (28.2%) had early closure, while 61 patients (71.8%) underwent late closure. The median operative time was 64.5 minutes, with a median post-operative hospital stay of six days. Complications occurred in 26 patients (30.6%), and 84.6% (22 patients) were Clavien-Dindo grade II. Surgical site infections (SSIs) were the most frequent complication. On multivariable analysis, early ileostomy closure (p = <0.001) was significantly associated with a higher rate of postoperative complications.

In our study, early closure of protective ileostomy was found to be associated with an increase in postoperative complications, mainly minor complications (Clavien-Dindo grade II). Although early reversal may offer benefits in reducing stoma-related problems, our findings highlight the importance of individualized patient selection, considering patient comorbidities, perioperative risk factors, and clinical context in order to optimize patient outcomes.