Loop versus end colostomy reversal: has anything changed?

B. R. Bruns, J. DuBose, J. Pasley, T. Kheirbek, K. Chouliaras, A. Riggle, M. K. Frank, H. A. Phelan, D. Holena, K. Inaba, J. Diaz, T. M. Scalea

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Purpose: Though primary repair of colon injuries is preferred, certain injury patterns require colostomy creation. Colostomy reversal is associated with significant morbidity and healthcare cost. Complication rates may be influenced by technique of diversion (loop vs. end colostomy), though this remains ill-defined. We hypothesized that reversal of loop colostomies is associated with fewer complications than end colostomies. Methods: This is a retrospective, multi-institutional study (four, level-1 trauma centers) of patients undergoing colostomy takedown for trauma during the time period 1/2006–12/2012. Data were collected from index trauma admission and subsequent admission for reversal and included demographics and complications of reversal. Student’s t test was used to compare continuous variables against loop versus end colostomy. Discrete variables were compared against both groups using Chi-squared tests. Results: Over the 6-year study period, 218 patients underwent colostomy takedown after trauma with a mean age of 30; 190 (87 %) were male, 162 (74 %) had penetrating injury as their indication for colostomy, and 98 (45 %) experienced at least one complication. Patients in the end colostomy group (n = 160) were more likely to require midline laparotomy (145 vs. 18, p < 0.001), had greater intra-operative blood loss (260.7 vs. 99.4 mL, p < 0.001), had greater hospital length of stay (8.4 vs. 5.5 days, p < 0.001), and had more overall complications (81 vs. 17, p = 0.005) than patients managed with loop colostomy (n = 58). Conclusions: Local takedown of a loop colostomy is safe and leads to shorter hospital stays, less intra-operative blood loss, and fewer complications when compared to end colostomy.

Original languageEnglish (US)
Pages (from-to)539-543
Number of pages5
JournalEuropean Journal of Trauma and Emergency Surgery
Volume41
Issue number5
DOIs
StatePublished - Oct 1 2015

Keywords

  • Colon
  • Colonic trauma
  • End colostomy
  • Loop colostomy
  • Stoma
  • Stoma reversal

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

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    Bruns, B. R., DuBose, J., Pasley, J., Kheirbek, T., Chouliaras, K., Riggle, A., Frank, M. K., Phelan, H. A., Holena, D., Inaba, K., Diaz, J., & Scalea, T. M. (2015). Loop versus end colostomy reversal: has anything changed? European Journal of Trauma and Emergency Surgery, 41(5), 539-543. https://doi.org/10.1007/s00068-014-0444-1