Proximal fecal diversion: review of ten years' experience

In a retrospective study, the clinical course of 250 patients subjected to 257 transverse colostomies was reviewed in an effort to evaluate the problems associated with proximal fecal diversion. Morbidity following stomal construction was 28 per cent, with a significant increase when performed in infants or as an emergency. Two-thirds of the colostomies were emergencies, chiefly due to obstruction and free perforation which was associated with a mortality rate of 12 and 48 per cent respectively. In 102 patients undergoing definite colorectal resection with a previous or simultaneous transverse colostomy, the overall morbidity rate was 58 per cent including a leakage rate of 22.5 per cent. Despite a proximal defunctioning colostomy, surgical intervention was required in 12.7 per cent with a fatal outcome due to peritonitis in 3.9 per cent. Colostomy closure was associated with a morbidity rate of 57 per cent, comprising a leakage rate of 10 per cent and a mortality rate of 1.7 per cent. Apart from incurable cancer and deaths prior to closure every third patient kept the transverse colostomy permanently. Advanced age and poor condition of patients not proceeding to a definite treatment, or an underlying benign lesion were the three most determining factors. The present results indicate a too extensive use of transverse colostomy, emphasizing the need for a circumspect initial selection of patients for diversionary procedures.