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SAGES 2026 Annual Meeting Emerging Technology Session
March 25-28, 2026 | Tampa, FL, USA
P407
Surgical Approach to Colon Resection with Colostomy Creation Influences Reversal Rates and Postoperative Outcomes: A Retrospective Longitudinal Analysis
Poster Presenter
Authors
Benjamin Perkins, Ena Novakovic, Alyssa Kozlowski, Andrew Schlussel
Affiliations
Part of Topic
Colorectal
Surgical Approach to Complicated Diverticulitis with Colostomy Creation Influences Reversal Rates and Postoperative Outcomes
Background:
Colostomy creation following colon resection for complicated diverticulitis is often intended as a temporary measure, but reversal rates remain low. Prior studies report that only 44–56% of patients ultimately undergo colostomy reversal, and fewer than one-third are reversed within one year. Comparative data on outcomes of open versus laparoscopic index resection and subsequent colostomy reversal are limited. Objective: To evaluate the impact of index surgical approach (open vs. laparoscopic) on colostomy reversal rates and perioperative outcomes in patients with complicated diverticulitis.
Methods:
●Design: Retrospective enterprise-wide review of adult patients (18–89 yrs) undergoing colon resection with colostomy creation for complicated diverticulitis
●Period: January 2022 – March 2025
●Stratification: Index surgical approach — open vs. laparoscopic
●Primary outcome: Rate of colostomy reversal
●Secondary outcomes: Predictors of reversal within one year; perioperative complications at index and reversal
●Statistics: Wilcoxon rank sum, chi-square, binomial logistic regression
Study population:
See poster for graphic
Demographics:
See poster for table
Results: Colostomy reversal was performed in 604 of 11,426 patients (5.3% overall). The rate was significantly higher after open index resection. See poster for table.
Predictors of reversal: Multivariable logistic regression — factors independently associated with colostomy reversal within one year. See poster for plot graph
Reversal perioperative outcomes: Among 604 patients who underwent reversal, laparoscopic approach yielded improved metrics
Key findings:
Open index resection → 2.5× higher odds of reversal (OR 2.53, 95% CI 2.05–3.32)
Laparoscopic reversal → shorter LOS (4 vs 6 days), fewer transfusions (21% vs 37%), lower complications
Intestinal perforation (OR 2.59) and obstruction (OR 2.22) were strong positive predictors of reversal
Smoking history and higher comorbidity reduced reversal likelihood (OR 0.66–0.68)
Clinical implications:
●Preoperative counseling should address the overall reversal rate (5.3%) regardless of approach
●Index approach may influence subsequent reversal likelihood when reversal is anticipated
●Laparoscopic techniques at reversal should be favored when feasible given superior perioperative outcomes
●Comorbidity optimization may improve reversal candidacy
Limitations:
●Retrospective design; subject to selection bias and unmeasured confounders
●Enterprise database may lack granularity on indication for index surgery and surgeon intent regarding ostomy temporariness
●The higher reversal rate after open resection may reflect unmeasured postoperative factors such as increased follow-up frequency, stoma-related complications prompting earlier surgical re-evaluation, or greater case complexity driving patient motivation for reversal; further research with prospective follow-up data is needed to clarify this relationship
●Reversal timing limited to one-year follow-up window; longer follow-up may capture additional reversals
●Limited to a single hospital system
Conclusions:
Open colon resection for complicated diverticulitis was associated with higher likelihood of subsequent colostomy reversal within one year. However, laparoscopic reversal was associated with improved perioperative outcomes, including shorter hospitalization and fewer complications.These findings suggest important tradeoffs between index operative approach and reversal outcomes and should inform patient selection and surgical decision-making. Further prospective studies are needed to elucidate the mechanisms driving the association between index approach and reversal likelihood.