Clinical Analysis Of 132 Cases Reversal Of Colostomy

Objectives:To summarize the experience of reversal of colostomy and explore the timing of operation,the way of operation and the risk factors for predicting the incidence of complications of reversal of colostomy.Methods:Retrospective analysis clinical data of 132 patients who under reversal of colostomy surgery in the First Affiliated Hospital of Nanchang University from November 2002 to November 2016,analysis of it's indications for reversal of colostomy,colostomy-reversal interval,stoma segment,surgical approach,operation time,postoperative hospital stay,postoperative complications.Results:There were 124 cases of open reversal of Hartmann's procedure and 8 cases of laparoscopic reversal of Hartmann's procedure.Conversion to open reversal of Hartmann's procedure was required for 2 patient,secondary to massive intraperitoneal adhesion.There were 4 patients' stoma site were in ascending colon,53 patients' stoma site were in transverse colon,75 patients' stoma site were in descending/ sigmoid colon.There were 104 cases of end colostomy and 28 cases of loop colostomy.The anastomosis was made hand sewn in 44 cases,while 88 cases were stapled.One of the reversal of the transverse colon stoma was performed as right colon resection for the first surgery was palliative resection.One of the reversal of the ascending colon stoma combined with parastomal hernia was performed as right colon resection.Two of the reversal of the transverse colon stoma was performed as tatol colon resection because of Congenital megacolon.One of the reversal of the cecum stoma was performed as right colon resection.The median colostomy-reversal interval was 5.5 months(1-180months).Colostomy-reversal interval of 3 cases were less than 3 months.Colostomy-reversal interval of 89 cases were between 3 to 6 months.Colostomy-reversal interval of 40 cases were more than 6 months.There were 24 complications(18.2%).Wound infection was diagnosed in 15 patients(11.4%).Anastomotic leakage was diagnosed in 4 patients(3%).Intestinal obstruction was diagnosed in 3 patients(2.3%).Anastomotic stenosis was diagnosed in 1 patients(0.8%).Abdominal infection was diagnosed in 2 patients(1.5%).Wound hemorrhage was diagnosed in 1 patients(0.8%).Mean operation time was 164.1 minutes.The mean length of hospital stay after surgery was 12.5 days.Conclusion:Temporary colon stoma usually needs to be reversaled,but it has a certain incidence of surgical complications.The most frequent complication was wound infection.The incidence of complications is related to operation skills.Subtly operation,appropriate stoma,suitable reversal way were needed to reduce the incidence of complications.There was no significant relationship between the incidence of complications and the time of reversal.Reversal can be made after 3-6 months of colostomy to reduce the impacts of colostomy on the patient's physiological and psychological.