Raising a colostomy--results of a prospective surgical audit

Abstract

A prospective surgical audit of all colostomies fashioned over a 1-year period in one hospital was conducted. Of one hundred and ten colostomies there were 56 loop and 52 end stomas. Following the formation of the colostomy a proforma was completed and the surgeon interviewed to document the precise surgical technique employed. Whilst in hospital the patients were regularly reviewed and the colostomies assessed by a surgeon and stomatherapist using a scoring system. Follow up was continued until closure of the colostomy or for a minimum period of 1 year. Only 53 (48%) of patients saw a stomatherapist preoperatively. This rate was higher in elective (86%) than in urgent cases (15%). The surgial technique used did not appear to influence the outcome of any given colostomy. However, failure to cruciate the posterior rectus sheath may predispose to stomal stenosis and the use of a subcutaneous polyethylene rod to support a loop colostomy often led to infection. Tension of the colostomy led to complications in 29 cases (26%), this was often the precipitating event to other complications and led to the only colostomy-related death. Registrars with experience of fewer than 5 colostomies received their training largely from other registrars rather than consultants. This prospective surgical audit has disclosed that fashioning a colostomy carries significant stoma related morbidity, most of which is potentially avoidable. Appropriate audit can contribute to the maintenance and improvement of surgical standards.