Studies indicate that the reversal of a temporary ileostomy can be safely performed early and no later than 12 weeks after creation. However, the latency between stoma creation and reversal is often significantly longer, up to 6 months, and not infrequently (9 - 57%) the reversal does not occur [1 - 4]. Reasons for a lack of reversal include advanced patient age, low body mass index, the presence of a terminal stoma, and neoadjuvant radiation therapy [2, 5, 6]. Other reasons include progression of the tumor disease, a primary procedure with complications, and particularly anastomotic insufficiency [1, 7].
There are hardly any recommendations in the literature for the optimal timing of ileostomy reversal, resulting in considerable variation in practice among different clinics [8].
In 2021, a high-evidence-level study was published examining postoperative complications after early reversal of a protective stoma (“early closure” [EC] ≤ 6 weeks vs. standard reversal (“standard closure” [SC] > 6 weeks) following rectal resection with an uneventful postoperative course [9]. Early reversal was not associated with a higher rate of postoperative complications. However, a prerequisite for early reversal is that patients do not undergo postoperative or adjuvant chemotherapy after the primary operation (rectal resection with protective stoma).
Regarding anastomotic technique, hand-sewn and stapled anastomoses are equivalent in terms of morbidity. Stapled anastomoses are associated with shorter operation times and a lower rate of postoperative obstruction [10], but also with higher costs [11]. Comparing hand-sewn end-to-end anastomoses with side-to-end anastomoses, the end-to-end anastomosis leads to increased morbidity and length of hospital stay [12].
The literature on skin closure after ileostomy reversal shows a significant advantage of purse-string suture over linear skin closure in terms of septic wound complications [13] with no differences in the rate of incisional hernias, operation duration, hospital stay, and patient quality of life [14].
An interesting alternative to the purse-string suture is skin closure using the Gunsight technique.