Loop versus end colostomy reversal: has anything changed?

PURPOSE: Though primary repair of colon injuries is preferred, certain injury patterns require colostomy creation. Colostomy reversal is associated with significant morbidity and healthcare cost. Complication rates may be influenced by technique of diversion (loop vs. end colostomy), though this remains ill-defined. We hypothesized that reversal of loop colostomies is associated with fewer complications than end colostomies. METHODS: This is a retrospective, multi-institutional study (four, level-1 trauma centers) of patients undergoing colostomy takedown for trauma during the time period 1/2006-12/2012. Data were collected from index trauma admission and subsequent admission for reversal and included demographics and complications of reversal. Student's t test was used to compare continuous variables against loop versus end colostomy. Discrete variables were compared against both groups using Chi-squared tests. RESULTS: Over the 6-year study period, 218 patients underwent colostomy takedown after trauma with a mean age of 30; 190 (87%) were male, 162 (74%) had penetrating injury as their indication for colostomy, and 98 (45%) experienced at least one complication. Patients in the end colostomy group (n = 160) were more likely to require midline laparotomy (145 vs. 18, p < 0.001), had greater intra-operative blood loss (260.7 vs. 99.4 mL, p < 0.001), had greater hospital length of stay (8.4 vs. 5.5 days, p < 0.001), and had more overall complications (81 vs. 17, p = 0.005) than patients managed with loop colostomy (n = 58). CONCLUSIONS: Local takedown of a loop colostomy is safe and leads to shorter hospital stays, less intra-operative blood loss, and fewer complications when compared to end colostomy.

Association of giant papillary conjunctivitis with seasonal allergies.

Giant papillary conjunctivitis (GPC) is largely a soft contact lens-related syndrome, characterized by the formation of giant papillae on the upper tarsal conjunctiva, itching, excess mucus, erythema, and contact lens intolerance. In response to the suggestion that GPC occurs more frequently in atopic individuals, a retrospective study was designed in order to determine the months in which patients were diagnosed with GPC during 1987 and 1988. Personal histories of allergy were also recorded for these patients, and compared to an age- and sex-matched control group. Significant peaks in the number of patients diagnosed with GPC occurred in the spring, and especially in late summer/early fall of both years. In addition, the GPC patients reported significantly more overall allergies than did the control group. However, a breakdown of the individual allergy data revealed that only allergies to contact lens solutions, specifically thimerosal, were significantly higher in the GPC group. Reported allergies to medications and pollen were also elevated in the GPC patients, but not significantly. The seasonal onset of GPC diagnoses in 1987 and 1988, and the increase in reported allergies within the GPC group, suggests a strong association between atopy and the development of GPC.