Timing of diverting ileostomy closure after low anterior resection for rectal cancer: a GRADE-assessed systematic review and meta-analysis of early and delayed closure.

In 30 seconds

This GRADE-assessed systematic review and meta-analysis compared early with delayed diverting ileostomy closure after low anterior resection for rectal cancer. It included five comparative studies—four randomised trials and one prospective cohort—with 512 participants. Overall post-closure morbidity was reported in 52/257 patients after early closure and 50/255 after delayed closure (RR 1.06, 95% CI 0.66-1.71). The analysis found no statistically significant difference in morbidity, severe complications, reoperation, hospital stay, or operative time; the evidence does not establish that the approaches are equivalent.

Key findings

• Overall morbidity occurred in 52/257 patients after early closure and 50/255 after delayed closure (RR 1.06, 95% CI 0.66-1.71).
• The index-to-closure interval was 107.09 days shorter with early closure (95% CI - 153.01 to - 61.17; I²=96%).
• Severe complications and reoperation did not differ statistically; confidence intervals were compatible with benefit or harm.
• Hospital stay and operative time did not differ statistically between early and delayed closure.

Why it matters

Ileostomy closure timing involves balancing earlier restoration of continuity against postoperative risk. This synthesis found no statistically significant morbidity difference, but its uncertainty means absence of a detected difference should not be interpreted as equivalence. The findings help frame timing as a decision requiring patient selection and assessment rather than a universally established early-closure strategy.

What to keep in mind

Only five comparative studies were included, and the confidence intervals for morbidity and other complications were compatible with benefit or harm. The index-to-closure interval had substantial heterogeneity (I²=96%) and was largely inherent to the group definitions.