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Out of the Loop: The Value of a Preoperative Loopogram for Colostomy Reversal in Trauma

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Stoma is occasionally fashioned during trauma surgery. A loopogram is routinely conducted in the surgical planning for stoma reversal. This is associated with medical and cost implications. A study was undertaken to evaluate the influence of loopograms on the management of trauma patients at a Johannesburg hospital.

Methods

A retrospective analysis of records in the stoma database (January 2013 to December 2018) was conducted. The patient demographics, method of injury, stoma-type, loopogram findings and post-operative courses were analysed.

Results

112 records were obtained. 9 (8%) patients were excluded for pending investigations or surgery. 13 (11.6%) patients were excluded for incomplete data. The remaining 90 (80.3%) patients, with a mean age of 32.9 had non-contributory loopograms and underwent a reversal procedure. 43 (47.8%) had a loop colostomy while 47 (52.2%) had undergone a Hartmann’s procedure. Mechanism of injury was stab wounds (81.4%L; 61.7%H); gunshot wounds (13.9%L; 29.7%H) and blunt trauma (L5% and 9%H). The post-operative complication rate was 30% for the loop group (2.3% ≥ Clavien-Dindo 3) and 25.5% for the Hartmann’s group (4% ≥ Clavien-Dindo 3). The average timing to reversal was 38 weeks (range 12–60) in the Hartmann’s group and 22 weeks (range 12–32) the loop colostomy group.

Conclusion

Significant findings are infrequent on loopogram for trauma patients. When these findings are detected, the effect on management is questionable. They are not without complications and have cost and time implications. Loopograms are helpful in selective cases rather than as a routine investigation, particularly in resource-limited settings.

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Authors and Affiliations

  1. University of Witwatersrand, Parktown, Johannesburg, 2193, South Africa

    Nolitha Makapi Tisetso Morare, Meshack Nkosinaye Motha & Maeyane Stephens Moeng

  2. Academic Head of Trauma, Charlotte Maxeke Johannesburg Academic Hospital, Parktown, Johannesburg, 2193, South Africa

    Maeyane Stephens Moeng

Authors
  1. Nolitha Makapi Tisetso Morare
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  2. Meshack Nkosinaye Motha
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  3. Maeyane Stephens Moeng
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Correspondence to Nolitha Makapi Tisetso Morare.

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All the authors declare no conflict of interest regarding the publication of this manuscript.

Ethical approval

This study was approved by the Human Research Ethics Committee of the University of Witwatersrand (M180558).

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Address where conducted: Charlotte Maxeke Johannesburg Academic Hospital Parktown, Johannesburg, 2193, South Africa

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Morare, N.M.T., Motha, M.N. & Moeng, M.S. Out of the Loop: The Value of a Preoperative Loopogram for Colostomy Reversal in Trauma. World J Surg 45, 2009–2014 (2021). https://doi.org/10.1007/s00268-021-06064-w

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  • DOI: https://doi.org/10.1007/s00268-021-06064-w

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