LIFE TABLE ANALYSIS OF STOMAL COMPLICATIONS FOLLOWING COLOSTOMY

PURPOSE: This study was designed to evaluate the longterm complication rate of left iliac fossa end sigmoid colostomies and to determine eti ologic factors. METHODS: A retrospective chart review and actuarial an alysis were performed. RESULTS: The crude and actuarial risks of parac olostomy complications in 203 patients were 51.2 percent and 58.1 perc ent at 13 years, respectively. Paracolostomy hernia was the most commo n complication (36.7 percent at 10 years). Siting the stoma through th e belly of the rectus abdominis muscle did not reduce the risk of hern ia, but an extraperitoneal course had a significantly lower risk of he rniation when compared with a transperitoneal course and intestinal ob struction was marginally less frequent. Paracolostomy hernias were oth erwise more likely in the elderly, and in those with other abdominal w all hernias. Mesenteric fixation did not reduce the subsequent chance of prolapse. The reduction in the risk of intestinal obstruction when lateral space closure was employed was not statistically significant ( 4 percent vs. 10 percent, P < 0.1), and all three patients with stomal retraction had had lateral space closure. CONCLUSION: The evidence in this study that spans a 22-year period questions much surgical techni cal dogma and raises the possibility that parastomal hernias may, like inguinal hernias, represent a failure in the transversalis fascia tha t might technically be avoidable.