Technique, timing, and wound management of closure colostomy

Abstract

Introduction: Colostomy closure is an operation frequently performed in surgical practice, despite its benefits, it can produce significant morbidity and mortality. We have focused on the complications related to this surgery in regard to the closure technique and the optimal time for stoma closure and on the proper wound management in the postoperative period. Patients and Methods: Ninety-six patients were male between 17 and 53 years (median 35), they have been subjected to colostomy closure surgery in single-layer (52 cases) and double-layer (44 cases) closure techniques according to the surgeon preference. The interval time for colostomy closure was more than 3 months in 56 cases, while the interval time was <3 months in 40 cases, and a primary wound closure for 87 cases and delayed (after few days) wound closure for 9 cases. The colostomies were created following penetrating abdominal trauma at Al-Yarmouk Teaching Hospital in a period between October 2003 and October 2007. Results: The total number of complications was 26 (27.08%), as fecal fistula 10 cases and wound infection 16 cases. Colostomy closure more than 3 months interval had 12.5% postoperative complications versus 47.5% if <3 months interval. Regarding single-layer anastomosis, 3.84% developed fecal fistula and (11.53%) developed wound infection versus 18.18% and 22.72%, respectively, in double-layer anastomosis group. No case developed wound infection with delayed wound closure versus 16 cases (18.39%) in primary wound closure. Discussion: The incidence of complications was more in double-layer (continuous) technique of closure colostomy versus single layer. While if the interval time for stoma closure is 3 months and more, it would give good results. Regarding wound management, delayed primary wound closure resulted in a better wound healing than the conventional skin closure technique. Conclusion: Based on this experience, we believe that colostomy closure can be performed with minimal morbidity and would result in a successful surgical outcome. Providing a meticulous technique used by a single layer (continuous seromuscular sutures plus stay sutures) anastomosis, more than three months interval time and a delayed wound closure the outcome will be much better.