title: Loop versus end colostomy reversal: has anything changed?
abstract: OBJECTIVE
  Though primary repair of colon injuries is preferred, certain injury patterns require colostomy creation. Colostomy reversal is associated with significant morbidity and healthcare cost. Complication rates may be influenced by technique of diversion (loop vs. end colostomy), though this remains ill-defined. We hypothesized that reversal of loop colostomies is associated with fewer complications than end colostomies.
  
  
  METHODS
  This is a retrospective, multi-institutional study (four, level-1 trauma centers) of patients undergoing colostomy takedown for trauma during the time period 1/2006-12/2012. Data were collected from index trauma admission and subsequent admission for reversal and included demographics and complications of reversal. Student's t test was used to compare continuous variables against loop versus end colostomy. Discrete variables were compared against both groups using Chi-squared tests.
  
  
  RESULTS
  Over the 6-year study period, 218 patients underwent colostomy takedown after trauma with a mean age of 30; 190 (87%) were male, 162 (74%) had penetrating injury as their indication for colostomy, and 98 (45%) experienced at least one complication. Patients in the end colostomy group (n = 160) were more likely to require midline laparotomy (145 vs. 18, p < 0.001), had greater intra-operative blood loss (260.7 vs. 99.4 mL, p < 0.001), had greater hospital length of stay (8.4 vs. 5.5 days, p < 0.001), and had more overall complications (81 vs. 17, p = 0.005) than patients managed with loop colostomy (n = 58).
  
  
  CONCLUSIONS
  Local takedown of a loop colostomy is safe and leads to shorter hospital stays, less intra-operative blood loss, and fewer complications when compared to end colostomy.
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Bbruns@umm.edu.
authors.forename: B R
authors.initials: BR
authors.lastname: Bruns
authors.affiliation: The University of Texas Health Science Center, Houston, TX, USA. Joseph.J.DuBose@uth.tmc.edu.
authors.forename: J
authors.initials: J
authors.lastname: DuBose
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Jpasley@umm.edu.
authors.forename: J
authors.initials: J
authors.lastname: Pasley
authors.affiliation: Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Tareq.Kheirbek@uphs.upenn.edu.
authors.forename: T
authors.initials: T
authors.lastname: Kheirbek
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, CA, USA. Chouliar@usc.edu.
authors.forename: K
authors.initials: K
authors.lastname: Chouliaras
authors.affiliation: Parkland Memorial Hospital, The University of Texas Southwestern, Dallas, TX, USA. Andrew.Riggle@phhs.org.
authors.forename: A
authors.initials: A
authors.lastname: Riggle
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Mfrank@stapa.umm.edu.
authors.forename: M K
authors.initials: MK
authors.lastname: Frank
authors.affiliation: Parkland Memorial Hospital, The University of Texas Southwestern, Dallas, TX, USA. Herb.Phelan@UTSouthwestern.edu.
authors.forename: H A
authors.initials: HA
authors.lastname: Phelan
authors.affiliation: Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Daniel.Holena@uphs.upenn.edu.
authors.forename: D
authors.initials: D
authors.lastname: Holena
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, CA, USA. Kenji.Inaba@med.usc.edu.
authors.forename: K
authors.initials: K
authors.lastname: Inaba
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Jdiaz@umm.edu.
authors.forename: J
authors.initials: J
authors.lastname: Diaz
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA. Tscalea@umm.edu.
authors.forename: T M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D012007:Rectum / Q000293:injuries* / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Colon; Colonic trauma; End colostomy; Loop colostomy; Stoma; Stoma reversal