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Reversible colostomy--what is the outcome?

K Mealy¹, E O'Broin, J Donohue

¹Department of Surgery, Meath Hospital, Dublin, Ireland.

Diseases of the Colon and Rectum

|November 1, 1996

Summary

Temporary colostomies have high complication rates and about half of patients do not have their stoma closed. This study examines colostomy morbidity and closure rates in large-bowel surgery patients.

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Area of Science:

Gastroenterology
Surgical Oncology
Colorectal Surgery

Background:

Temporary colostomies are frequently used in elective and emergency large-bowel surgery.
Concerns exist regarding the morbidity associated with colostomy formation and closure, and low rates of stoma reversal.
This perceived morbidity drives a trend toward avoiding colostomies.

Purpose of the Study:

To evaluate the persistent high rates of colostomy-related morbidity.
To assess the outcomes of temporary colostomy formation and closure in patients undergoing large-bowel surgery.

Main Methods:

A retrospective review of 120 patients who underwent a potentially reversible colostomy.
Patients were categorized based on whether the surgery was elective or emergency.
Data on colostomy-related complications and closure rates were analyzed.

Main Results:

Colostomy-related morbidity (stenosis, retraction, prolapse, hernia) occurred in 19.2% of patients, with similar rates in elective (14.9%) and emergency (21.9%) groups.
Initial colostomy closure was performed in 59.2% of patients, with the highest rates in the diverticular disease group (84.6%).
The final colostomy closure rate was 54.2%, with a 35.2% complication rate during closure, including the need for a second colostomy in 8 patients.

Conclusions:

Both the formation and closure of defunctioning colostomies are associated with significant complications.
Approximately 50% of patients will not have their colostomy closed, indicating a persistent challenge in stoma reversal.
The findings support the need for careful consideration of temporary colostomy use due to associated morbidity and low closure rates.

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