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Murine Distal Colostomy, A Novel Model of Diversion Colitis in C57BL/6 Mice
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Loop versus end colostomy reversal: has anything changed?

B R Bruns1, J DuBose2, J Pasley3

  • 1R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Bbruns@umm.edu.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|June 4, 2015
PubMed
Summary
This summary is machine-generated.

Reversing a loop colostomy after trauma is safer and leads to fewer complications than reversing an end colostomy. This study found loop colostomy takedown resulted in shorter hospital stays and less blood loss.

Keywords:
ColonColonic traumaEnd colostomyLoop colostomyStomaStoma reversal

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Area of Science:

  • Colorectal Surgery
  • Trauma Surgery
  • Surgical Outcomes

Background:

  • Colostomy creation is sometimes necessary for colon injuries.
  • Colostomy reversal is associated with significant morbidity and healthcare costs.
  • The technique of diversion (loop vs. end colostomy) may influence complication rates, but this is not well-defined.

Purpose of the Study:

  • To test the hypothesis that reversal of loop colostomies is associated with fewer complications than end colostomies.
  • To compare complication rates between loop and end colostomy reversal in trauma patients.

Main Methods:

  • Retrospective, multi-institutional study across four level-1 trauma centers.
  • Inclusion of patients undergoing colostomy takedown for trauma between January 2006 and December 2012.
  • Statistical analysis using Student's t test for continuous variables and Chi-squared tests for discrete variables to compare loop versus end colostomy groups.

Main Results:

  • Over 6 years, 218 patients underwent colostomy takedown; 45% experienced at least one complication.
  • End colostomy patients (n=160) were more likely to require midline laparotomy, had greater intra-operative blood loss, longer hospital stays, and more overall complications compared to loop colostomy patients (n=58).
  • Specific complication differences included higher rates of midline laparotomy (p < 0.001), blood loss (p < 0.001), and hospital length of stay (p < 0.001) in the end colostomy group.

Conclusions:

  • Local takedown of a loop colostomy is a safe procedure.
  • Loop colostomy reversal is associated with shorter hospital stays, less intra-operative blood loss, and fewer complications compared to end colostomy reversal.
  • These findings support loop colostomy as a preferred diversion technique when reversal is anticipated.