Design: GRADE-assessed systematic review and meta-analysis
Population: 512 patients in 5 studies after low anterior resection with diverting ileostomy
Primary outcome: Overall post-closure morbidity
Effect: RR 1.06 (0.66 to 1.71), I² 40%

This GRADE-assessed meta-analysis pooled five studies, four randomised trials and one prospective cohort, with 512 patients who had a diverting ileostomy after low anterior resection for rectal cancer. It compared early with delayed closure.

Overall morbidity after closure was 52 of 257 with early closure and 50 of 255 with delayed closure (RR 1.06, 95% CI 0.66 to 1.71, I² 40%). Severe complications, reoperation, hospital stay and operative time did not differ, with intervals compatible with either benefit or harm. Early closure shortened the time with a stoma by about 107 days, which follows from how the groups were defined.

The evidence does not show early closure is worse, but it does not show it is as safe either. For a patient who has recovered well and whose anastomosis has been checked, early closure is a reasonable option to discuss, particularly where stoma care is a burden or a high-output stoma threatens kidney function. It is not a reason to change routine practice for everyone.

Consider early closure in selected patients who have recovered well and have a confirmed intact anastomosis.
Check the anastomosis before any early closure, as all included trials did.
Weigh stoma-related problems such as high output and dehydration when choosing timing.
Keep delayed closure for patients still recovering or due adjuvant chemotherapy.
Explain to patients that the evidence is uncertain rather than settled.

Why it matters

Months with a stoma carry their own harms, and the case for waiting is weaker than habit suggests.

The statistics, in plain English

An RR of 1.06 with an interval from 0.66 to 1.71 means early closure could plausibly lower morbidity by a third or raise it by 70%. That width is why the authors say equivalence is not established.