Outcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia

Background: Colostomy creation and reversal procedures are common procedures, frequently performed by surgeons working in Ethiopia. Collected information is lacking concerning the outcome of colostomy reversal procedures in the country.
Methods: A hospital based retrospective analysis was undertaken to describe the patterns of patients who underwent colostomy reversal, the timing of colostomy reversal, the frequently witnessed complications and the postoperative outcomes of patients admitted to the Tikur Anbessa and Saint Paul hospitals in Ethiopia for colostomy reversal procedure. Data was collected from 87 patients.
Results: The majority of patients were males 70(82.8%). Seventy-six (87.4%) of the colostomies were situated in sigmoid colon and Hartmann's colostomy was the most common type in 64 (60.6%). Most colostomies, 69 (79.3%), were created for non-trauma related disease conditions. The interval from the colostomy creation to colostomy closure varied from 8 weeks (2 months) to 72 weeks (18 months) with a mean interval of 28.2 weeks (6.6 months). Most, 71(81.6%) of the procedures were performed by consultant surgeons and the frequently used method was the two layered hand-sewn method in 72 (82.8%) patients. The overall incidence of complication was 17 (19.5 %). The rate of anastomotic leakage is 4(4.6 %). One patient who underwent sigmoid colostomy reversal done initially for gangrenous sigmoid volvulus died after anastomotic leak, making the overall mortality rate 1.1%. More complications occurred during Hartmann's colostomy reversals. The morbidity rate for reversal performed within 16 weeks (4 months) of its creation was 3/28 (10.7%) for those within 16 to 24 weeks, 0/28 (0%); and for those after 24 weeks, 1/29 (3.4%).
Conclusions and recommendations: Colostomy reversal is a commonly performed procedure in our setting and should be well mastered by consultant surgeons and residents under training. The associated morbidity and mortality are found to be low. It appears that delayed reversal is more advantageous and safer than early reversal procedures.