Proximal fecal diversion

Abstract

The clinical course of 250 patients subjected to 257 transverse colostomies [for the management of colorectal lesions] was retrospectively reviewed in an effort to evaluate the problems associated with proximal fecal diversion. Morbidity following stomal construction was 28%, with a significant increase when performed in infants or as an emergency. Two-thirds of the colostomies were emergencies, chiefly due to obstruction and free perforation which was associated with a mortality rate of 12 and 48% respectively. In 102 patients undergoing definite colorectal resection with a previous or simultaneous transverse colostomy, the overall morbidity rate was 58% including a leakage rate of 22.5%. Despite a proximal defunctioning colostomy, surgical intervention was required in 12.7% with a fatal outcome due to peritonitis in 3.9%. Colostomy closure was associated with a morbidity rate of 57%, comprising a leakage rate of 10% and a mortality rate of 1.7%. Apart from incurable cancer and deaths prior to closure every 3rd patient kept the transverse colostomy permanently. Advanced age and poor condition of patients not proceeding to a definite treatment or an underlying benign lesion were the 3 most determining factors. A too extensive use of transverse colostomy is indicated, emphasizing the need for a circumspect initial selection of patients for diversionary procedures.