Colostomy closure as seen at kenyatta national hospital both retrospective and prospective study

Abstract

This is both a prospective study of thirty patients from March 2002 to February 2003 and a retrospective study of eighty-five patients from January 1999 to February 2002 who underwent colostomy closure at the Kenyatta National Hospital. There was no significant difference in the results of the two groups. The main objective of the study was to analyse variables that determine outcome of colostomy closure. All patients who met the inclusion criteria were recruited into the study. The average age of patients in the prospective group was 34 (range, 15-85) years and 35 (range 16-87) years in the retrospective group. There were more males than females in the study with a male to female ratio of 5:1 and 4.3:1 in the prospective and retrospective groups respectively. The common indications for colostomy were colon injury and colon obstruction accounting for more than eighty five percent (85%) of the patients. Hartman's colostomy was the commonest type of colostomy fashioned accounting for fifty percent (50%) and 44.7% of the colostomies in the prospective and retrospective studies 'respectively. Seventy percent (70%) of the colostomies in the prospective group and 58.8% of those in the retrospective group were sited at the sigmoid colon. Mean time until colostomy closure was 7.6 (range, 0.82 to 91) months in the prospective group and 5.3 (range, 0.79 to 29) , months in the retrospective group. All the patients had mechanical bowel preparation. Seventy three percent (73%) in the prospective group and 63.3% in the retrospective group had prophylactic systemic antibiotics. All the patients had intraperitoneal closure of the colostomy. About ninety percent (90%) of the patients in the study had two-layer anastomosis of the colon. About sixty percent (60%) of the patients in the study had their colostomies closed in less than two hours. The average hospital stay for patients in the prospective group was 7.1 (range, 2 to 18) days and 9.8 (range, 4 to 61) days in the retrospective group. The rate of developing early complications was 16.7% in the prospective group of which 13.4% had wound infection and 15.3% in the retrospective group of which 11.8% had wound infection. There was no death. There was a trend of increasing morbidity in patients who had colon obstruction, colostomies sited at the sigmoid colon, Hartman's colostomy, operations lasting more than two hours and those operated by Registrars.