The revisional burden of colostomy: a temporal analysis of risk, patterns, and survival

This study analyzed patients who underwent colostomy revision to identify risk factors and complications, aiming to provide evidence-based recommendations for the guidelines.

Of 339 colostomy patients treated between 2016 and 2023, 58 who underwent colostomy revision were designated as the study group and compared with 281 non-revision patients in the control group.

Of the 339 patients, 58 (17.1%) underwent 78 revision procedures (mean: 1.34 revisions per patient). Early revisions (within 30 days) comprised 60.3% of all procedures (n = 47), primarily due to necrosis (38.3% of early revisions) and retraction (29.8% of early revisions). Late revisions (after 30 days) accounted for 39.7% (n = 31), mainly for parastomal hernia (25.8% of late revisions) and stenosis (19.4% of late revisions). Twenty patients (34.5%) required multiple revisions; the revision group had a higher mean age (66.1 ± 11.8 vs. 61.8 ± 12.1 years, p = 0.021), more females (53.4% vs. 38.0%, p = 0.045), and more emergency surgeries (58.6% vs. 40.5%, p = 0.003). Transverse colostomies had a higher revision rate (24.7%) than sigmoid colostomies (13.8%), p = 0.045.

Colostomy revision is associated with significant morbidity and mortality rates. Advanced age, female sex, emergency surgery, and transverse colostomy were identified as independent risk factors. Early complications (necrosis and retraction) differ from late complications (hernias and stenosis). Many patients require multiple revisions, highlighting the need for tailored surgical strategies and updated guidelines to minimize the number of revisions and improve the outcomes.