Risk factors in colostomy closure.

A retrospective study of 69 patients who underwent colostomy closure between 1973 and 1978 was conducted to evaluate three categories of risk: predisposing risk factors, preoperative interventions, and intraoperative techniques. The overall morbidity rate was 44% with no deaths. Factors associated with a greater complication rate included a divided colostomy (especially Hartmann's pouch), diverticulitis, elderly patients, and lack of preoperative oral antibiotics. Irrigation of the distal segment in divided colostomies and preoperative use of systemic antibiotics in association with oral agents, particularly neomycin-erythromycin, may be effective in decreasing morbidity. Factors that did not influence morbidity included time between colostomy and closure, wound management intraoperatively, the use of systemic antibiotics alone, and the location of loop colostomies. With careful preparation of the patient to combat the documented risk factors, colostomy closure may be safely undertaken in most patients.