Complications of colostomy closure.

The records of 83 patients with 85 colostomy closures at Charity Hospital, New Orleans from January 1976 through June 1981 were reviewed. There were 47 complications in 30 patients (36 percent) with no deaths. The material used for anastomosis and fascial closure, the precipitating or underlying disease, the site of colostomy, and the length of operation did not influence the complication rate. The major factor affecting the complication rate was the interval of time from creation of the colostomy to its closure. Those patients who underwent closure after a 90 day interval had a lower overall complication rate than comparison groups with less than a 30 day interval and 30 to 90 day intervals (p less than 0.05). Other factors that appeared to influence the complication rate were as follows: loop colostomies had a lower suture line complication rate than divided colostomies, patients who underwent relaparotomy and closure had a higher complication rate than those whose closures were confined to the colostomy site, and wounds left open or that underwent delayed primary closure had a lower infection rate than wounds closed primarily. Thus, loop colostomies appear to have fewer complications at the time of closure than divided stomas. This is most likely related to the necessity for relaparotomy in some of the patients with divided stomas and the need for minimal mesenteric dissection required for most loop colostomy patients. Divided stomas should still be created if indicated, but when a choice exists, loop colostomies are preferable. Contaminated wounds are best managed with secondary closure or delayed primary closure. Because of the significant difference in complication rates between intervals from formation to closure of a colostomy, all patients should have their colostomies closed only after a minimum of 90 days has elapsed.