<p>Background/Aim. Loop ileostomy is commonly performed during rectal cancer surgery to reduce anastomotic complications. Postoperative ileus, a frequent complication following ileostomy reversal, can prolong recovery and elevate healthcare costs. However, specific risk factors for ileus after ileostomy reversal have not been thoroughly investigated. This study aimed to evaluate the incidence of postoperative ileus following loop ileostomy closure and to analyze the effects of closure timing and anastomotic technique on ileus development in rectal cancer patients. Methods. A retrospective cohort study was conducted on 43 patients who underwent ileostomy closure after rectal resection for adenocarcinoma. Patients were categorized by postoperative ileus development within 30 days of closure. Demographic and clinical factors were assessed for their association with ileus development, with ileus incidence as the primary outcome and potential risk factors as secondary outcomes. Results. Postoperative ileus occurred in 30.2% of patients. Hand-sewn anastomosis was identified as a significant risk factor associated with a higher rate of ileus than stapled anastomosis (p = 0.024). Patients with ileus also experienced more extended hospital stays (p &lt; 0.001) and higher 30-day readmission rates (p = 0.042). Although patients with ileus had a longer median interval from initial surgery to closure, this difference was insignificant (p = 0.243). Conclusion. Postoperative ileus following loop ileostomy reversal was a common complication, affecting nearly one-third of patients. Hand-sewn anastomosis was a significant predictor of ileus, associated with extended hospital stays and higher readmission rates.</p>