Optimizing ileostomy closure timing after laparoscopic rectal resection

Background: Protective diverting ileostomy is widely adopted to reduce the clinical impact of anastomotic leakage after rectal cancer surgery. Despite its protective role, prolonged stoma duration is associated with impaired quality of life, increased morbidity, delayed recovery, and higher healthcare costs. The optimal timing of ileostomy closure after laparoscopic anterior resection, particularly in patients receiving perioperative chemotherapy, remains controversial. Methods: Between September 1, 2024 and 2025, 30 elective laparoscopic anterior resections with total mesorectal excision were performed at two peripheral general surgery units in Calabria, Italy. Twenty patients with low rectal cancer (≤6 cm from the anal verge) received a temporary protective ileostomy and were included in the analysis. Ileostomy closure was defined as early when performed within 30 days after primary surgery (n = 14) and late when performed after 30 days (n = 6). Outcomes analyzed included operative time for stoma closure, postoperative recovery, length of hospital stay, time to initiation of adjuvant chemotherapy, duration of stoma, and ostomy-related healthcare costs. Statistical significance was set at P < 0.05. Results: No significant differences were observed between groups regarding operative time, postoperative bowel function, or length of hospital stay. Early ileostomy closure was associated with a significantly shorter duration of stoma and a marked reduction in ostomy-related healthcare costs ( P < 0.001). Time to initiation of adjuvant chemotherapy differed significantly between groups ( P < 0.05), although the absolute difference was clinically modest and remained within acceptable oncological timeframes. Conclusions: Early ileostomy closure after laparoscopic rectal resection appears to be safe and effective in carefully selected patients. This strategy significantly reduces stoma burden and healthcare costs without adversely affecting postoperative recovery or causing clinically relevant delays in adjuvant chemotherapy. Further large-scale prospective and randomized studies are needed to validate these findings.