Three-week ileostomy closure after colorectal surgery: a multicenter randomized trial of technical and postoperative outcomes

The optimal timing of temporary ileostomy closure following restorative colorectal surgery remains controversial. Although previous randomized studies have demonstrated the feasibility of early closure in carefully selected patients, the influence of closure timing on operative complexity has not been prospectively evaluated. This multicenter randomized controlled trial compared a standardized 3-week ileostomy closure strategy with conventional delayed closure, with particular emphasis on technical and postoperative outcomes.

In this prospective multicenter randomized controlled trial, 224 patients undergoing restorative colorectal resection with temporary diverting ileostomy were randomized to either early ileostomy closure at 3 weeks (n = 112) or conventional delayed closure (n = 112). Eligibility for reversal required rigorous confirmation of anastomotic healing using standardized clinical and endoscopic assessment, with selective computed tomography using rectal contrast when clinically indicated. The primary outcome was operative complexity, evaluated using operative duration, intraoperative adhesion severity, and the requirement for extended adhesiolysis. Secondary outcomes included postoperative morbidity, Clavien-Dindo complication grade, length of hospital stay, readmission, reoperation, re-diversion, and delay in adjuvant chemotherapy.