Early colostomy closure appears successful in some

Last Updated: 2018-11-29

By David Douglas

NEW YORK (Reuters Health) - After undergoing the Hartmann procedure for diverticulitis, certain patients may benefit from colostomy reversal within a matter of months, according to Connecticut-based researchers.

Timing to colostomy reversal is largely surgeon based and, given the lack of guidelines, "is widely variable," Dr. Kevin Y. Pei and colleagues at Yale School of Medicine, in New Haven, note in JAMA Surgery, online November 21.

To further examine the situation, the researchers scrutinized data from California, Florida and Maryland covering more than 7,000 patients who underwent colostomy for diverticulitis and had subsequent reversal. Of these, 28.3% underwent reversal within a year.

After excluding those who had readmissions between the index surgery and reversal, the team analyzed data on 1,660 patients.

The median time to reversal was 129 days. Mortality, transfusion, ileus and major complications were not significantly different among those who underwent the reversal at 45 to 110 days or at a later point.

However, prolonged length of stay (odds ratio, 1.62) and 90-day readmissions (OR, 1.61) were significantly more likely in those who had reversal after more than 110 days.

Thus, the researchers conclude, "In selected patients with an uncomplicated course, improved outcomes are associated with earlier reversal, and colostomy reversal is safe as early as 45 to 110 days after the index procedure."

Dr. Marc D. Basson, author of an accompanying editorial, told Reuters Health by email, "This was an interesting paper that clearly demonstrates that it is possible to close colostomies in selected patients at an early time point with reasonable outcomes."

However, Dr. Basson, of the North Dakota School of Medicine & Health Sciences, in Grand Forks, pointed out, "It remains unclear exactly how to select such patients and whether these patients would have had even better outcomes if more time had elapsed prior to closure."

"The study," he concluded, "should not be taken as a mandate for early colostomy closure in all patients."

Dr. Pei did not respond to requests for comments.

SOURCE: https://bit.ly/2Ayqwc1 and https://bit.ly/2KGLSsl

JAMA Surg 2018.