Purpose: Creation of a temporary ostomy is a surgical tool to divert stool from a more distal area of concern (anastomosis, inflammation, etc). To provide a true benefit, the morbidity/mortality from the ostomy takedown itself should be minimal. Aim of our study was therefore to evaluate our own experience and determine the complications and mortality of stoma closure in relation to the type and location of the respective ostomy. MethodsPatients who underwent an elective takedown of a temporary ostomy at our teaching institution between 01/1999 and 07/2005 were included in our analysis, and the medical records retrospectively reviewed. Excluded were only patients with relevant chart deficiencies. Data collected included general demographics, the type and location of the stoma, the operative technique, and the type, timing and impact of complications.
Results:156 patients (median age 45 years, range 23-85) were included in the analysis: 68 Hartmann's reversals, 32 loop colostomy closures, and 56 ileostomy takedowns. Mean follow-up was 6 months. The overall mortality rate was low (0.65%, 1/156 patients). However, the morbidity rate was 33% (51 patients), with 5 (3%) systemic complications and 46 (30%) local complications. Minor would infection (34 patients, 21.8%) and postoperative ileus (9 patients, 5.8%) were the most common surgery-related complications, but generally resolved with conservative management. Anastomotic leak and formation/persistence of an enterocutaneous fistula (5 patients, 3.2%) was the most serious local complications and required re-intervention in all of the patients. Closure of a loop colostomy accounted for 42% complication and Hartmann reversal accounted for 41% complications, as opposed to a complication rate of 18% for ileostomy takedowns.
Conclusion:Takedown of a temporary ostomy has a low mortality but a non-negligible morbidity. The stoma location (large vs. small bowel) has a higher impact than the type of stoma construction (end vs. loop) on the incidence and severity of complications.