COLOSTOMY CLOSURE - OCHSNER CLINIC EXPERIENCE

We retrospectively reviewed the records from our past five years of ex perience with colostomy closure at a large multispecialty hospital to determine postoperative morbidity. RESULTS: From March 1988 to April 1 993, 46 patients underwent colostomy closure. Patients ranged in age f rom 24 to 87 (mean, 41.8) years and 25 (54 percent) were women. Stomas had been created during emergency operations in 40 patients (87 perce nt); most operations (54 percent) were for complications of acute dive rticulitis. Of the 46 procedures, 40 (87 percent) were end colostomies , and 6 were loop colostomies. Stomas were closed at a range of 11 to 1,357 days after creation (mean, 207 days; median, 116 days). Twenty-s ix patients (57 percent) underwent colostomy closure alone, and the re mainder underwent additional procedures ranging from appendectomy to h epatic lobectomy. Duration of operations ranged from 1 to 9.5 (mean, 4 .2) hours, and estimated blood loss averaged 400 mi. Overall hospital stay for closure was 6 to 62 (mean, 11.5) days. Inpatient complication s occurred in 15 percent of patients, including congestive heart failu re (2 percent), cerebrovascular accident (4 percent), pneumonia (2 per cent), enterocutaneous fistula (2 percent), and pulmonary embolus wit h death (2 percent). The most common longterm complication was midline wound hernia, which occurred in 10 percent of surviving patients. Ove rall, complications occurred in 24 percent. CONCLUSIONS: Colostomy clo sure is a major operation; however, with good surgical judgment and te chnique, associated morbidity and mortality can be minimized.