Colostomy closure: how to avoid complications
Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described.
The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48–72 h after the operation.
The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung’s disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic stricture and no mortality.
Based on this experience we believe that colostomy closure can be performed with minimal morbidity provided a meticulous technique is observed.
- Kiely EM, Sparnon AL (1987) Stoma closure in infants and children. Pediatr Surg Int 2:95–97
- Millar AJK, Lakhoo K, Rode H et al (1993) Bowel stomas in infants and children. A 5-year audit of 203 patients. S Afr J Surg 3:110–113
- Rees BI, Thomas DFM, Negam M (1982) Colostomies in infancy and childhood. Z Kinderchir 36:100–102
- Ekenze SO, Agugua-Obianyo NEN, Amah CC (2007) Colostomy for large bowel anomalies in children: a case controlled study. Int J Surg 5:273–277 CrossRef
- Mollitt DL, Malangoni MA, Ballantine TVN et al (1980) Colostomy complications in children. An analysis of 146 cases. Arch Surg 115:445–458
- Uba AF, Chirdan LB (2003) Colostomy complications in children. Ann Afr Med 2:9–12
- Steinau G, Ruhl KM, Hornchen H et al (2001) Enterostomy complications in infancy and childhood. Langenbeck’s Arch Surg 386:346–349 CrossRef
- Das S (1991) Extraperitoneal closure of colostomy in children. J Indian Med Assoc 89:253–255
- Chandramouli B, Srinivasan K, Jagdish S et al (2004) Morbidity and mortality of colostomy and its closure in children. J Pediatr Surg 39:596–599 CrossRef
- Miyano G, Yanai T, Okazaki T et al (2007) Laparoscopy-assisted stoma closure. J Laparoendosc Adv Surg Tech A 17:395–398 CrossRef
- Figueroa M, Bailez M, Solana J (2007) Morbilidad de la colostomia en ninos con malformaciones anorrectales (MAR). Cir Pediatr 20:79–82
- Nour S, Beck J, Stringer MD (1996) Colostomy complications in infants and children. Ann R Coll Surg Engl 78:526–530
- Dobe CO, Gbobo LI (2001) Childhood colostomy and its complications in Lagos. East Central Afr J Surg 6:25–29
- Macmahon RA, Cohen SJ, Eckstein HB (1963) Colostomies in infancy and childhood. Arch Dis Child 38:114–117 CrossRef
- Rickwood AMK, Hemlatha V, Brooman P (1979) Closure of colostomy in infants and children. Br J Surg 66:273–274 CrossRef
- Brenner RW, Swenson O (1967) Colostomy in infants and children. Surg Gynecol Obstet 124:1239–1244
- Pena A, Migotto-Krieger M, Levitt MA (2006) Colostomy in anorectal malformations: a procedure with serious but preventable complications. J Pediatr Surg 41(4):748–756 CrossRef
- Nichols RL, Broido P, Condon RE et al (1973) Effect of preoperative neomycin–erythromycin in intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg 178:453–459 CrossRef
- Ordorica-Flores RM, Bracho-Blanchet E, Nieto-Zermeno J et al (1998) Intestinal anastomosis in children: a comparative study between two different techniques. J Pediatr Surg 33:1757–1759 CrossRef
- Garcia-Osogobio SM, Takahashi-Monroy T, Velasco L et al (2006) Single-layer colonic anastomoses using polyglyconate (Maxon) vs. two-layer anastomoses using chromic catgut and silk. Rev Invest Clin 58:198–203
- McAdams AJ, Meikle AG, Taylor JO (1970) One layer or two layer colonic anastomoses? Am J Surg 120:546–550 CrossRef
- Dinsmore JE, Maxson RT, Johnson DD et al (1997) Is nasogastric tube decompression necessary after major abdominal surgery in children? J Pediatr Surg 32:982–985 CrossRef
- Nelson R, Edwards S, Tse B (2005) Prophylactic nasogastric decompression after abdominal surgery. Cochrane database of systematic reviews (1):CD004929 (online)
- Colostomy closure: how to avoid complications
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Pediatric Surgery International
Volume 26, Issue 11 , pp 1087-1092
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Anorectal malformation
- Colonic surgery
- Industry Sectors