Bhullar JS, Busbait SA, Herman K, Chitragari G, Singh JP, Drelichman ER. Timing of diverting loop ileostomy closure after rectal resection: Commentary on recent findings. World J Gastrointest Surg 2025; 17(12): 114274 [DOI: 10.4240/wjgs.v17.i12.114274]
Corresponding Author of This Article
Jasneet S Bhullar, Department of Surgery, Henry Ford Providence Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075, United States. drjsbhullar@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Dec 27, 2025; 17(12): 114274 Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.114274
Timing of diverting loop ileostomy closure after rectal resection: Commentary on recent findings
Jasneet S Bhullar, Saleh A Busbait, Koby Herman, Gautham Chitragari, Jai P Singh, Ernesto R Drelichman
Jasneet S Bhullar, Saleh A Busbait, Koby Herman, Gautham Chitragari, Jai P Singh, Ernesto R Drelichman, Department of Surgery, Henry Ford Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
Saleh A Busbait, Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
Co-corresponding authors: Jasneet S Bhullar and Saleh A Busbait.
Author contributions: Bhullar JB, Busbait SA, Herman K, Chitragari G, Singh JP, and Drelichman ER designed the concept and outline and contributed to the writing and review of literature; Bhullar JB, Busbait SA, and Drelichman ER were responsible for oversight and coordination; Bhullar JB and Busbait SA contributed equally to this article, they are the co-corresponding authors of this manuscript. All authors contributed to the editing of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jasneet S Bhullar, Department of Surgery, Henry Ford Providence Hospital, Michigan State University College of Human Medicine, 16001 W Nine Mile Rd, Southfield, MI 48075, United States. drjsbhullar@gmail.com
Received: September 16, 2025 Revised: October 19, 2025 Accepted: October 30, 2025 Published online: December 27, 2025 Processing time: 101 Days and 3.4 Hours
Abstract
The clinicians remain uncertain about the ideal timing for loop ileostomy reversal following rectal resection surgery. The common practice of waiting 8-12 weeks to protect from anastomotic complication, especially in patients who receive neoadjuvant chemoradiotherapy, would expose patients to dehydration, electrolyte disturbances, stoma related complications, and reduced quality of life. Randomized controlled trials have studied early reversal of ileostomy, with results ranging from improved outcomes in selected patients to increased morbidity when applied indiscriminately. Meta-analyses have also yielded heterogeneous findings, reflecting the need for careful patient selection. The study by Özcan and Düzgün used retrospective methods to show that patients who underwent early closure experienced similar complication rates to those who had late closure, but early closure were associated with better quality of life. Taken together, current evidence suggests that reversal within 2-4 weeks may be safe and beneficial in meticulously selected patients with an intact anastomosis and an uneventful postoperative course. Their study provides practical data supporting early closure. It is limited, however, by being retrospective with a short follow-up period, which may leave important concerns unaddressed. Multicenter randomized trials are required to help establish safe standardized criteria for early closure and long-term safety.
Core Tip: This commentary highlights that while traditional delayed closure protects the anastomosis, it imposes substantial patient burden. Recent retrospective data suggest that ultra-early (10-14 days) reversal may be safe and improve quality of life, but this aggressive strategy warrants cautious interpretation and prospective validation to define ideal candidates.
