The morbidity and cost of the temporary colostomy

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Abstract
The charts of 167 patients undergoing colostomy construction and closure were reviewed. The incidence of complications related to the construction of the colostomy was 9.6%. No death occurred with closure of the 167 colostomies, but 50 patients (29.9%) sustained complications. Fecal fistulas occurred in 6 patients (3.6%). The combined reoperation rate for colostomy construction and closure for problems related to the colostomy was 11.6%. The mean period of hospitalization for combined construction and closure of a temporary colostomy was 39.4 days. The median interval from construction to closure was 101 days. Mean anesthesia time for colostomy closure was 165 min. The identifiable means to reduce the high morbidity and cost of the temporary colostomy are: meticulousness in planning and construction of the colostomy stoma; where possible and appropriate, construction of a loop colostomy in preference to an end colostomy. When by necessity an end colostomy is constructed, it is important to approximate the 2 divided ends of the colon at the time of colostomy construction and thereby facilitate its subsequent closure; early closure of the colostomy (2-3 mo.); minimizing the period of hospitalization prior to closure of the colostomy; the use of antibiotics with bowel preparation for colostomy closure; and where appropriate, the selective use of alternatives to colostomy, such as exteriorization or primary repair of colonic injury.

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