- Design
- Multicentre randomised controlled trial
- Population
- 224 patients with temporary diverting ileostomy after restorative colorectal resection
- Primary outcome
- Operative complexity: duration, adhesion severity, extended adhesiolysis
- Effect
- 90 vs 130 min (P<0.001); extended adhesiolysis 5.4% vs 21.4% (P<0.001)
A multicentre randomised trial enrolled 224 patients with a temporary diverting ileostomy after restorative colorectal resection. Reversal required confirmed anastomotic healing on clinical and endoscopic assessment, with contrast CT when indicated. Patients were randomised to closure at 3 weeks or conventional delayed closure; the primary outcome was operative complexity.
Early closure was associated with shorter operations (90 vs 130 minutes), less severe adhesions, and much less need for extended adhesiolysis (5.4% vs 21.4%). Overall morbidity, complication grades, length of stay, readmission, reoperation and mortality were similar. Chemotherapy was delayed by 1–4 weeks in 3.6% of the early group and none of the delayed group; all of those patients went on to receive it.
This adds to earlier trials that early closure is feasible in selected patients, and shows the operation itself is easier before dense adhesions form. The key is selection: patients had to have a healed anastomosis confirmed first. Coordination with oncology matters, because reversal falls in the window when adjuvant chemotherapy would start.
- Consider reversing a diverting ileostomy at about 3 weeks when the anastomosis is confirmed healed.
- Confirm healing with endoscopy, and contrast CT where there is doubt, before booking early reversal.
- Agree timing with oncology so early reversal does not push back adjuvant chemotherapy.
- Expect a shorter operation with less adhesiolysis than reversal at the usual later date.
Why it matters
Months living with a stoma may not be necessary for patients who have healed, and the reversal is technically easier early.
Don't overread it
Patients were carefully selected with proven anastomotic healing; the trial was not powered for rare complications.
The statistics, in plain English
Forty minutes shorter and a fall in extended adhesiolysis from about one in five to one in twenty are large, clearly significant differences. The trial's primary outcome was operative difficulty; it was not powered to show differences in rarer complications such as anastomotic leak.
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