Changing patterns in colostomy closure: the Bristol experience 1975-1982.

The results of colostomy closure in 113 patients (1975-1982) were examined to determine whether the identification of risk factors or improvements in surgical management had made this procedure safer. Overall mortality was low (0.9 per cent), but faecal fistulas occurred in 16.5 per cent and the incidence of wound infection was high (34 per cent). Comparison of the first and second 4 year periods shows recent improvements in the rates of wound infection (24 versus 51 per cent: P less than 0.01) and anastomotic leakage (10 versus 30 per cent: P less than 0.05). A long delay (greater than 6 months) between creation and closure of the colostomy was associated with an increased incidence of postoperative diarrhoea compared with shorter periods of defunction (38 versus 14 per cent: P less than 0.01). The morbidity of colostomy closure is decreasing but remains an important clinical problem.