Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer (CRC) surgery and perforation or to relieve intestinal obstruction.

To analyze the complications after transverse colostomy closure.

Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical center. The differences between the complication group and the no complication group were compared. Logistic regression analyses were conducted to find independent factors for overall complications or incision infection.

A total of 102 patients who underwent transverse colostomy closure were enrolled in the current study. Seventy (68.6%) patients underwent transverse colostomy because of CRC related causes. Postoperative complications occurred in 30 (29.4%) patients and the most frequent complication occurring after transverse colostomy closure was incision infection (46.7%). The complication group had longer hospital stays (P < 0.01). However, no potential risk factors were identified for overall complications and incision infection.

The most frequent complication occurring after transverse colostomy closure surgery in our center was incision infection. The operation time, interval from transverse colostomy to reversal, and method of anastomosis might have no impact on the postoperative complications. Surgeons should pay more attention to aseptic techniques.

This study was undertaken to review and summarize the complications of ileostomy and colostomy creation and subsequent closure.

The English-language medical literature for at least the past 15 years was reviewed comprehensively.

Complications of surgery for the creation of end, loop, and "end loop" stomas are presented. Technical factors, which might influence complication rates, are discussed. Optimal management of ostomy complications is presented, especially for peristomal hernias. Similarly, techniques and complications for stoma closure are analyzed.

Stoma creation is not a trivial undertaking; careful surgical technique minimizes complications (which are relatively frequent), and promotes good ostomy function. Peristomal hernias are difficult to cure permanently. The morbidity of ileostomy and colostomy closure is also appreciable.

The purposes of this project were to study the healing of protected rectal wounds (RWs) using contrast enemas (CEs) and to establish the safety of same admission colostomy closure (SACC) in terms of colostomy closure (CC) and rectal wound-related outcomes, for selected patients with radiologically healed RWs.

Traditional treatment of RWs has included a diverting colostomy that is closed 2 or more months later during a readmission.

All patients admitted with a rectal injury were entered into this prospective study, treated with a diverting colostomy and presacral drainage, and managed according to a postoperative protocol that included a CE per anus to detect healing of the RW. Patients with no leaking on their first CE, no infection, and anal continence underwent SACC.

From 1990 to 1993, 30 consecutive patients had rectal injuries, 90% of which resulted from gunshot wounds. The first CE was performed in 29 patients 5 to 10 days after injury. In this group, 21 patients did not and 8 did have leakage from their RWs. The proportions of RWs radiologically healed at 7 and 10 days after injury were 55.2% and 75%, respectively. Sixteen patients with a normal CE underwent SACC 9 to 19 days after injury (mean, 12.4 days). There were two fecal fistulas (2 of 7; 28.6%) after simple suture closure, none (0 of 9) after resection of the stoma with end-to-end anastomosis, and no RW-related complications after SACC. The mean hospitalization time was 17.4 days.

The following conclusions were drawn: (1) CE confirmed healing of RWs in 75% of patients by 10 days after injury; (2) 60% of patients with RWs were candidates for SACC, and 53% were discharged with their colostomies closed; (3) SACC was performed without complications in 87.5% of patients with radiologically healed RWs; and (4) there were no RW-related complications after SACC.

A retrospective study of 87 patients, subjected to colostomy closure between 1976 and 1987, was conducted in order to evaluate the role of 8 potential risk factors on morbidity and mortality. Possible risk factors were age greater than 65 years, presence of hypoalbuminaemia (less than 3.0 gr%), anaemia (Hb less than 10 gr%), operative technique, duration of colostomy, site of colostomy, underlying disease and presence of subcutaneous drainage. Apart from hypoalbuminaemia, no clear risk factor was identified, although an interval of more than 90 days between construction and closure of colostomy appears to be safer than shorter intervals. A comparison was also made between two different periods from 1976 to 1982 and from 1983 to 1987 which resulted in important changes in patient management in the second period including: type of antibiotic prophylaxis, type of anastomosis and suture material, site of colostomy and mean duration of colostomy. Four post-operative deaths (4.6%) (two for myocardial insufficiency and two for sepsis), 11 major (13%) and 25 (29%) minor complications were recorded. The analysis of the two different periods showed a strong reduction in both mortality and morbidity in the second period, which could be related to a better management of this type of patient. In conclusion, the incidence of mortality and morbidity in colostomy closure cannot be underestimated and therefore the same skill and meticulous approach are required for this operation as for any major surgical procedure on the colon.

The healing of a standardized left colon anastomosis after early (7 days) closure of a concomitant proximal diverting colostomy was studied experimentally. Early closure of the diverting colostomy could be conducted safely by an intraperitoneal technique and the healing of the primary anastomosis was uncomplicated. Colostomy closure in the proliferative phase of wound healing resulted in development of anastomotic strength similar to colonic healing without faecal diversion. The anastomotic strength had doubled after three weeks. As compared to colostomy closure in the remodelling phase of anastomotic healing development of anastomotic strength was more rapid and without serious local complications.

Early colostomy closure leads to a high rate of fecal fistula formation which may be due to a poor blood supply. Laser Doppler flowmetry is a new method of measuring colonic blood flow. Blood flow in 17 colostomies has been measured at one week, median flux 28 units (range, 13 to 43) and in 12 colostomies more than eight weeks after formation, median flux 46 units (range, 35-56; P less than 0.002). Nine of the "mature" colostomies have been closed without a fecal fistula or other signs of anastomotic failure. Serial readings of colostomy blood flow were made at weekly intervals in another ten stomas over a period of two months. Blood flow increased over this time from a median of 19 units (range, 17 to 22) at one week to a median of 44 units (range, 39 to 48; P less than 0.002) at eight weeks. Laser Doppler flowmetry is a simple, noninvasive method of measuring colostomy blood flow and the findings support a clinical policy for delayed colostomy closure.

Early surgical complications following colostomy closure in 65 cancer patients operated on at the Istituto Nazionale Tumori of Milan were evaluated retrospectively. The overall complication rate was 24.6 per cent, including infections (13.8 per cent), fistulas (6.1 per cent), wound dehiscence (3.0 per cent), and distal stenosis (1.5 per cent). Type and rate of complications were analyzed to find a correlation with type, site, and location of colostomy, technique of closure, presence or absence of drains, or time interval between construction and closure of colostomy. No statistically significant association between the aforementioned factors and occurrence and rate of complications was found. The authors think, therefore, that surgical attention, including meticulous manipulation of the stoma, avoidance of contamination of the wound, tension of sutures, dead spaces, and collection of blood in the wound, and use of antibiotics and antiseptics are the most important principles to minimize postoperative complications.

The use of a temporary colostomy is essential in the management of trauma, carcinoma, iatrogenic perforations, diverticulitis, and a number of congenital anomalies of the colon. Closure of a colostomy can be associated with a significant complication rate and even mortality and should not be considered a minor procedure. This is a retrospective study of 114 patients undergoing closure of colostomy, in which an attempt was made to investigate and single out the factors determining complications of colostomy closure. The results point toward timing and technique of closure as the two main factors determining complications associated with colostomy closure.

All large-bowel stomas (198) performed between 1970 and 1980 in a community hospital were reviewed. Twenty-nine stomas were loop transverse colostomies. There were five deaths, a complication rate related to the stoma of 28 per cent, and only 18 patients ever achieved colostomy closure. Our conclusions are as follows: (1) transverse colostomy is a holdover from the past; (2) "temporary" loop colostomy is a misnomer; (3) all colostomies should be end-bearing and matured primarily; (4) blind surgery invites tragedy; (5) loop transverse colostomy is a risky first stage with little benefit; (6) every colostomy should be placed as near as possible to the disease process; and (7) resection of the disease is the ideal first stage.

Fistula formation following closure of a colostomy occurs most frequently when closure is carried out within the first few weeks of construction and may be related to an impaired local microcirculation. Using a recently described method for measuring colonic mucosal-submucosal blood flow, the variations in local flow which occur during the first month after colostomy construction were determined in 8 patients. Mean blood flow increased from 6.9 +/- 1.8 ml min-1 100 g-1 (s.d.) at 7 days to 31.1 +/- 12.5 ml min-1 100 g-1 (s.d.) at 28 days. In a further 40 consecutive patients undergoing colostomy closure, blood flow measurements were made before operation. Eight patients developed a faecal fistula, and in 5 of these patients mucosal-submucosal blood flow was found to be less than 15 ml min-1 100 g-1. In every successful colostomy closure blood flow was greater than 15 ml min-1 100 g-1. This study provides evidence that a subnormal blood flow is one of the factors associated with fistula formation following the operation of colostomy closure.