Does colostomy (surgical creation of an opening in the colon) closure mean the colostomy is still present?

Colostomy Closure Means the Colostomy is Removed, Not Still Present

No, colostomy closure means the colostomy has been surgically removed and intestinal continuity has been restored, eliminating the stoma from the abdominal wall. When healthcare providers refer to "colostomy closure," they are describing a surgical procedure to reverse the colostomy and reconnect the bowel, allowing stool to pass through the normal anatomical route again 1.

Understanding Colostomy Types and Closure

Types of Colostomies

• End colostomy: Created when the intestine is divided and the proximal end is brought out as a stoma while the distal end remains within the abdomen 1
• Loop colostomy: Both the proximal and distal limbs of the bowel are brought to the skin surface, creating a stoma with two openings 1
• Temporary vs. Permanent: Colostomies may be created with the intention of being temporary (with planned closure) or permanent (when restoration of bowel continuity is not possible)

The Closure Procedure

The closure procedure involves:

1. Surgical mobilization of the stoma from the abdominal wall
2. Resection of the exteriorized portion of bowel
3. Anastomosis (reconnection) of the bowel ends
4. Closure of the abdominal wall defect

Clinical Considerations for Colostomy Closure

Timing of Closure

• Optimal timing for colostomy closure is typically after at least 90 days from creation 2
• Earlier closure (before 12 weeks) is associated with significantly higher complication rates 3
• This waiting period allows for:
  • Resolution of inflammation and edema
  • Optimization of nutritional status
  • Stabilization of the patient's underlying condition

Factors Affecting Closure Success

• Type of colostomy: Loop colostomies generally have fewer complications at closure compared to end colostomies 2
• Location: Left-sided colostomies have higher complication rates during closure 3
• Patient factors: Hypoalbuminemia and steroid dependence significantly increase risks 4, 5

Potential Complications

• Wound infection (occurs in approximately 19% of cases) 3
• Anastomotic breakdown (occurs in approximately 7.7% of cases) 3
• Mortality rate of 2.5-4.8% 3, 4

Important Distinctions

When Closure May Not Be Possible

According to ESMO guidelines, although closure or reversal of colostomy is documented in the literature, it should be considered the exception rather than the rule 1. In many cases, particularly after high-dose radiation therapy for anal cancer, the colostomy becomes permanent because:

• Fecal incontinence or anal stenosis often persists due to radiation effects on the anal sphincters
• Patients should be counseled that their pre-treatment colostomy will likely be permanent 1

Special Considerations

• In Fournier's gangrene cases, colostomy may be performed for fecal diversion to protect wounds, but subsequent closure would be considered after complete healing 1
• In rectal obstruction cases, stoma placement should be planned with consideration of future surgical resection and potential for closure 1

Conclusion

When medical professionals discuss "colostomy closure," they are referring to a surgical procedure that removes the stoma and restores intestinal continuity. After successful closure, the patient no longer has a colostomy, though they will have a surgical scar at the former stoma site. This procedure carries significant risks and should be approached with the same care as any major bowel operation 6.