eP116 - Transverse Blowhole Colostomy versus Hartmann’s Procedure for Urgent Management of Large Bowel Obstruction Secondary to Diverticular Stricture

Purpose/Background: Large bowel obstruction causing significant proximal colonic dilation is considered a surgical emergency, most commonly addressed with a Hartmann’s procedure. There is little data in the literature regarding management of large bowel obstruction secondary to a diverticular stricture. A Hartmann’s procedure carries significant post-operative morbidity, and many of these colostomies are never reversed. The goal of this study was to evaluate the use of a transverse blowhole colostomy as the first stage in management of acute diverticular large bowel obstruction compared to a Hartmann’s.Methods/Interventions: A retrospective chart review was performed, evaluating all patients from a single institution who had a Hartmann’s procedure for large bowel obstruction secondary to diverticular disease from 2012 to 2023 and all patients who had a transverse blowhole colostomy for the same indication. Rates of ostomy reversal and post-operative outcomes between the two groups were compared. The primary outcomes studied were rate of colostomy reversal and the approach to reversal (open vs minimally invasive). Secondary outcomes included post-operative complications such as 30-day readmission, 30-day re-operation, 30-day mortality, deep/superficial surgical site infection, blood transfusion requirement, cardiac complications, nasogastric tube placement for ileus, and incisional hernia.Results/Outcomes: We identified 39 patients who presented with large bowel obstruction related to diverticular disease initially managed via an open Hartmann’s procedure, and 15 patients managed via a blowhole colostomy. There was no significant difference in age, sex, BMI, or comorbidities between the two groups. Comparing the index operations, the blowhole colostomy group had a significantly shorter length of stay (post-operatively) than the Hartmann’s group (median 5 vs 8 days, p= 0.014). The Hartmann’s group also had more deep surgical site infections (6.7% vs 15.4%), though this was not statistically significant. None of the other post-operative outcomes were different between the two groups. More patients in the blowhole colostomy group had their stomas reversed at 80% vs 56.4% (p= 0.11). The median time to reversal was also shorter in this group at 3 months vs 4.7 months after index operation (p= 0.012). Reversal was more often performed with a minimally invasive approach in the blowhole group, but this did not reach significance (83.3% vs 50%, p= 0.075). There was no difference in proximal diversion after colostomy reversal. The post-operative outcomes after reversal were not significantly different.Conclusion/

Discussion: Transverse blowhole colostomy creation is a promising option for a staged approach to diverticular large bowel obstruction. In this study, these patients were more likely to have their stomas reversed and closer to the time of index operation. Other benefits to this approach include shorter length of stay after index operation and higher likelihood of colostomy reversal being performed with a minimally invasive approach.