Three-week ileostomy closure after colorectal surgery: a multicenter randomized trial of technical and postoperative outcomes.
Y Debakey, M S Mostafa, A Kilany et al.
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In 30 seconds
This prospective multicenter randomized trial compared ileostomy closure at 3 weeks with conventional delayed closure in 224 patients after restorative colorectal resection. Reversal was undertaken only after standardized assessment confirmed anastomotic healing. Early closure was associated with shorter operative duration (90 ± 12 vs. 130 ± 18 min; P < 0.001), lower adhesion severity, and less need for extended adhesiolysis (5.4% vs. 21.4%; P < 0.001). Short-term postoperative outcomes were comparable between groups. Delays in adjuvant chemotherapy occurred only after early closure, affecting 3.6% of that group, but all affected patients subsequently started treatment.
Key findings
- Operative duration was 90 ± 12 vs. 130 ± 18 min with early versus delayed closure (P < 0.001).
- Extended adhesiolysis was required in 5.4% vs. 21.4% of patients, respectively (P < 0.001).
- Postoperative morbidity, complication grades, length of stay, readmission, reoperation, and mortality were comparable between groups.
- Adjuvant chemotherapy was delayed in 3.6% of the early-closure group; all affected patients subsequently commenced planned treatment.
Why it matters
Closure timing may affect the technical burden of ileostomy reversal, not just postoperative recovery. In this trial, a carefully assessed 3-week strategy reduced operative complexity without an observed difference in short-term postoperative outcomes. The chemotherapy delays confined to the early-closure group are also relevant when weighing timing against the need to proceed with planned oncologic treatment.
What to keep in mind
The findings apply to carefully selected patients with confirmed anastomotic healing; the abstract reports short-term outcomes and does not establish effects beyond the reported follow-up.