EARLY CLOSURE OF COLOSTOMIES IN TRAUMA PATIENTS - A PROSPECTIVE RANDOMIZED TRIAL

Background. Most traumatic colon injuries can be repaired primarily, b ut a colostomy may still be required for severe colonic or rectal inju ry. The current trend is to reverse the colostomy early, rather than t o wait the traditional 3 months before closure. Methods. Forty-nine pa tients with colostomies after abdominal trauma were entered into the s tudy. All patients had undergone a contrast enema in the second postop erative week to assess distal colon healing. Patients were excluded fr om early closure for nonhealing of the bowel injury, unresolving wound sepsis, or an unstable condition. We then compared the outcome of the remaining 38 (77.6%) patients allocated to either an early or a late colostomy group in a controlled, prospective, randomized trial. Result s. We found no significant difference in morbidity between the two gro ups, with an overall complication rate of 26.3%. Technically the early closure of colostomies was far easier than late closure and required significantly less operating time (p = 0.036) and with less intraopera tive blood loss (p = 0.020). The closure of end colostomies was more t ime consuming, both early (p < 0.001) and late (p < 0.001) and caused more bleeding (p < 0.001 and p < 0.001, respectively). Total hospitali zation was marginally shorter overall for early closure, but late clos ure of end colostomies resulted in prolonged hospitalization (p = 0.02 3). Conclusions. The early closure of colostomies aid the use of loop colostomies whenever possible are recommended as both safe and benefic ial for patients with colonic injury after trauma. Contraindications f or early closure include nonhealing distal bowel, persistent wound sep sis, or persistent postoperative instability.