INTESTINAL OSTOMY CLOSURE: FACTORS ASSOCIATED WITH DELAY AND IMPACT ON PATIENT QUALITY OF LIFE

Abstract

Temporary intestinal ostomies are created to protect high-risk anastomoses or to manage emergency colorectal conditions, yet their intended reversibility does not guarantee timely restoration of bowel continuity. This narrative review aimed to analyze factors associated with delayed ostomy closure and to discuss how prolonged stoma status and subsequent reversal affect patient quality of life. Literature searches were performed in 2026 in PubMed/MEDLINE and SciELO, with complementary consultation of current colorectal surgery guidelines. Evidence addressing temporary ileostomy or colostomy closure, non-reversal, treatment-related delays, postoperative complications, care pathways, and patient-reported outcomes was prioritized. The literature indicates that anastomotic leakage, intra-abdominal infection, advanced or recurrent malignancy, greater comorbidity burden, higher anesthetic risk, older age, and the complexity of Hartmann reversal can postpone or prevent closure. Adjuvant chemotherapy frequently prolongs the interval, although recent data suggest that chemotherapy alone should not automatically preclude closure in appropriately selected patients. Organizational factors, including delayed referral and sequential scheduling of imaging, outpatient review, and operative listing, can also extend stoma duration. While reversal often improves body image, physical well-being, social participation, work, and sexual function, it may expose patients to bowel dysfunction, including low anterior resection syndrome. Therefore, timing should be individualized, distinguishing clinically necessary delay from potentially avoidable delay and incorporating oncologic safety, anastomotic integrity, operative risk, functional expectations, and patient preferences.