Prospective Study on the Safety and Feasibility of Early Ileostomy Closure 2 Weeks After Lower Anterior Resection for Rectal Cancer

Purpose: Transient loop ileostomies in rectal cancer surgery are generally closed after 2 or more months to allow adequate time for anastomotic healing. Maintaining the ileostomy may cause medical, surgical, or psychological complications; it also reduces the quality of life, and increase treatment costs. We performed this study to evaluate the safety and feasibility of early ileostomy closure 2 weeks postoperatively.

Methods: If a patient who underwent total mesorectal excision had 2 or more risk factors for anastomotic leakage, a loop ileostomy was created. After confirmation of intact anastomosis via sigmoidoscopy and proctography 1 week postoperatively, the patient was enrolled and ileostomy was closed 2 weeks postoperatively. The primary endpoint was the frequency of complication after ileostomy repair.

Results: Thirty patients were enrolled in the study and 6 were excluded due to anastomotic leakage. Except for 1 case of wound infection (4.2%), no patient experienced any complication including newly developed leakage after the ileostomy closure. The mean duration to repair was 13.1 days (range, 8-16 days) and mean duration to the start of adjuvant treatment after radical surgery was 5.37 weeks (range, 3.0-8.1 weeks).

Conclusion: Transient loop ileostomy, which is confirmed to be intact endoscopically and radiologically, can be safely closed 2 weeks postoperatively without requiring a significant delay in adjuvant chemotherapy.