Colostomy wound closure

T. V. Berne, C. N. Griffith, J. Hill and P. LoGuidice

The management of the wound at the time of colostomy closure has been controversial, and wound infection is a frequently cited complication of this procedure. We have conducted a prospective randomized study of colostomy wound closure in 105 patients with three study groups: (1) primary closure (n = 38); (2) primary closure with subcutaneous drains (n = 29); and (3) delayed primary closure (n = 38). All patients had mechanical bowel preparation with whole gut lavage as well as oral neomycin sulfate/erythromycin estolate and perioperative parenteral cefazolin sodium (Ancef). Five wound infections (4.8%) occurred. Three infections were in the delayed primary closure group and one infection in each of the other two study groups. No statistical difference in wound infection was demonstrated. On the basis of the findings in this study, we would not recommend delayed primary closure for the management of colostomy closure wounds when careful mechanical and antibiotic preparation has been utilized.