Optimal timing of ileostomy closure after rectal surgery: A Bayesian network meta-analysis of randomized controlled trials.

PurposeTemporary ileostomy is commonly performed to protect rectal anastomosis after rectal surgery, yet the optimal timing of reversal remains unsettled. This study compared postoperative outcomes among early, intermediate, and late ileostomy closure and assessed the safety of early closure in selected patients.MethodsPubMed, Web of Science, and Embase were systematically searched from inception to June 21, 2026. Randomized controlled trials comparing different timing strategies for ileostomy closure were included. Closure timing was categorized according to the reported median or mean interval from primary surgery to reversal as early (≤ 35 days), intermediate (> 35 and ≤ 120 days), and late (> 120 days) based on the median or mean interval. The primary outcomes were total postoperative complications and major complications. A Bayesian network meta-analysis was performed.ResultsTen randomized trials involving 871 patients (316 early, 312 intermediate, and 243 late) were included. Total postoperative complications were comparable among the three groups. Compared with intermediate closure, early closure was associated with higher risks of major complications (odds ratio [OR] 5.30, 95% credible interval [CrI] 1.30-63.00) and wound complications (OR 4.80, 95%CrI 1.10-35.00), but a lower risk of stoma-related complications (OR 0.086, 95%CrI 0.0057-0.82). No significant differences were observed between early and late closure or between intermediate and late closure. In patients without clinical or radiological evidence of anastomotic leakage, total and major complication rates were similar across groups.ConclusionEarly ileostomy closure may be feasible and safe in carefully selected patients without evidence of anastomotic leakage, reducing stoma-related complications at the expense of increased wound complications.