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Peer-reviewedCC BY-NC-ND 4.0Langenbeck's Archives of Surgery

Timing of diverting ileostomy closure after low anterior resection for rectal cancer: a GRADE-assessed systematic review and meta-analysis of early and delayed closure

  • Wajahat Mirza1
  • Sana Ehsan Ullah2
  • Muhammad Babar3
  • Raja Nand4
  • Umaima Mehmood Hiraj5
  • Inamullah Soomro6
  • Fatima Saeed7
  • Rao Nouman Ali5
7 affiliations
  1. 1Shifa College of Medicine, Shifa Tameer-e-Millat University, Sector H-8/4, Islamabad, Pakistan
  2. 2General Surgery, Recep Tayyip Erdogan Hospital, The Indus Hospital & Health Network, Muzaffargarh, Pakistan
  3. 3Services Hospital, Lahore, Pakistan
  4. 4Basic Health Unit, Chachi Moora, Pakistan
  5. 5District Headquarters Hospital, Khanewal, Pakistan
  6. 6Dow Medical College, DUHS, Karachi, Pakistan
  7. 7Wah Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
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Abstract

Purpose: To compare early and delayed diverting ileostomy closure after low anterior resection for rectal cancer, focusing on postoperative morbidity and recovery outcomes, and to assess the certainty of available evidence.

Methods: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception to 26th April, 2026. Five comparative studies (four randomized trials and one prospective cohort; 512 participants) were included. Random-effects meta-analyses evaluated overall post-closure morbidity as the primary outcome and severe complications, index-to-closure interval, postoperative hospital stay, operative time, and reoperation as secondary outcomes. Certainty was assessed using GRADE.

Results: Overall morbidity occurred in 52/257 patients after early closure and 50/255 after delayed closure (RR 1.06, 95% CI 0.66–1.71; τ²=0.12; I²=40%). Severe complications and reoperation did not differ statistically, with confidence intervals compatible with benefit or harm. The index-to-closure interval was 107.09 days shorter with early closure (95% CI − 153.01 to − 61.17; τ²=2023.39; I²=96%); this process measure was largely inherent to the group definitions. Hospital stay and operative time did not differ statistically.

Conclusion: The available evidence does not demonstrate a statistically significant difference in postoperative morbidity but does not establish equivalence. Early closure may be considered in selected patients after postoperative recovery and assessment of anastomotic integrity; however, these findings do not support routine early closure in all patients.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00423-026-04350-6.

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Cite

BibTeXRIS
BibTeX
@article{mirza2026timing,
  title = {{Timing of diverting ileostomy closure after low anterior resection for rectal cancer: a GRADE-assessed systematic review and meta-analysis of early and delayed closure}},
  author = {Wajahat Mirza and Sana Ehsan Ullah and Muhammad Babar and Raja Nand and Umaima Mehmood Hiraj and Inamullah Soomro and Fatima Saeed and Rao Nouman Ali},
  journal = {Langenbeck's Archives of Surgery},
  year = {2026},
  month = oct,
  doi = {10.1007/s00423-026-04350-6},
  url = {https://doi.org/10.1007/s00423-026-04350-6},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Timing of diverting ileostomy closure after low anterior resection for rectal cancer: a GRADE-assessed systematic review and meta-analysis of early and delayed closure
AU  - Wajahat Mirza
AU  - Sana Ehsan Ullah
AU  - Muhammad Babar
AU  - Raja Nand
AU  - Umaima Mehmood Hiraj
AU  - Inamullah Soomro
AU  - Fatima Saeed
AU  - Rao Nouman Ali
PY  - 2026
DA  - 2026/10/24
JO  - Langenbeck's Archives of Surgery
DO  - 10.1007/s00423-026-04350-6
UR  - https://doi.org/10.1007/s00423-026-04350-6
AB  - Purpose: To compare early and delayed diverting ileostomy closure after low anterior resection for rectal cancer, focusing on postoperative morbidity and recovery outcomes, and to assess the certainty of available evidence.  Methods: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception to 26th April, 2026. Five comparative studies (four randomized trials and one prospective cohort; 512 participants) were included. Random-effects meta-analyses evaluated overall post-closure morbidity as the primary outcome and severe complications, index-to-closure interval, postoperative hospital stay, operative time, and reoperation as secondary outcomes. Certainty was assessed using GRADE.  Results: Overall morbidity occurred in 52/257 patients after early closure and 50/255 after delayed closure (RR 1.06, 95% CI 0.66–1.71; τ²=0.12; I²=40%). Severe complications and reoperation did not differ statistically, with confidence intervals compatible with benefit or harm. The index-to-closure interval was 107.09 days shorter with early closure (95% CI − 153.01 to − 61.17; τ²=2023.39; I²=96%); this process measure was largely inherent to the group definitions. Hospital stay and operative time did not differ statistically.  Conclusion: The available evidence does not demonstrate a statistically significant difference in postoperative morbidity but does not establish equivalence. Early closure may be considered in selected patients after postoperative recovery and assessment of anastomotic integrity; however, these findings do not support routine early closure in all patients.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00423-026-04350-6.
SN  - 1435-2443
SN  - 1435-2451
ER  -