Early vs Delayed Temporal Ileostomy Closure after Low Anterior Resection (LAR) in Patients with Rectal Cancer, A Cohort Study

Abstract Background The optimal timing for ileostomy closure remains controversial, most of the surgeons are closing ileostomy after 6-8 weeks, although ileostomy closure considered a simple procedure, it can cause significant morbidity; this study aims to clarify any relation between the post-closure complications rate and the time from its creation to the repair. Objective To compare between early ileostomy closure within 2 weeks and delayed ileostomy closure after 6 weeks regarding post closure complications (anastmotic leak – intra abdominal collection – intestinal obstruction –SSI),operative time, post operative hospital stay and quality of life improvement. Patients and Methods This is a A cohort study. Data was collected from departments of Ain Shams university hospitals as colorectal department and oncology department. Results The overall post-closure complications in our study was 37.5%, there was no significant difference between the overall complications rate for both early and late closure groups (35% and 40%) respectively (P value 0.534), The majority of the complications were intestinal obstruction, and superficial surgical site infection, there was significant association between the interval to ileostomy reversal and the intestinal obstruction, it was higher in the late closure group, in the other hand the surgical site infection complication found to be not significantly higher in the early closure group than the late closure group (25% Vs 15%) with (P value 0.428). Conclusion Our study revealed that the duration between the creation of protective ileostomy and its reversal was not a significant independent predictor of post-closure complications rate. Depending on whether a patient has mild pre-closure complications and appears tolerant of the psychological effect of his stoma, the ileostomy closure can be deferred safely for a real indication such as completing adjuvant chemotherapy without concern that the longer duration to closure will increase the postoperative complications rate. We sincerely hope that our effort adds to the body of evidence until a consensus regarding the ileostomy closure timing is reached.