Outcome of loop versus divided colostomy in the management of anorectal malformations

Abstract

BACKGROUNDColostomy is a common part of the management of high anorectal malformation (ARM) in the pediatric population.OBJECTIVETo evaluate whether the type of colostomy (loop vs divided) has an impact on outcome in patients with ARM.DESIGNA retrospective study.SETTINGKing Faisal Specialist Hospital and Research Center, a tertiary care center.PATIENTS AND METHODSAll patients who were managed with colostomy for ARM and had definitive repair during the period of January 2000 to December 2014. Outcomes relative to the type of the colostomy were compared.MAIN OUTCOME MEASURESMorbidities associated with each type of colostomy.RESULTSThere were 104 patients managed for ARM with colostomy as staged procedures, 63 males and 41 females. Patients had a colostomy at a median age of 6 days and were closed at a median of 11 months. Definitive repair was at a median age of 17 months. Type of fistula was 8 perineal, 21 rectovestibular, 35 rectourethral, 11 rectovesical and there were 16 without fistula and 13 cloaca anomalies. There were 55 loop and 49 divided colostomies. There were 91 descending/sigmoid and 13 transverse colostomies. Operative time for loop colostomy closure was shorter than with divided colo6stomy (76 minutes vs 94 minutes, P=.002). Three patients among the divided group had reversed orientation of the colostomy that had affected bowel preparations negatively prior to its repair. There was no differences in complications of creation and closure of loop and divided colostomies except in occurrence of skin excoriation. There was more skin excoriation with divided colostomy compared to loop colostomy (17 vs 10, P=.04).CONCLUSIONSLoop colostomy has a shorter closure operative time and relatively fewer complications compared to the divided colostomy. Our data suggests that loop colostomy may be more favorable than divided colostomy for ARM patients.LIMITATIONSRetrospective nature of the study and some colostomies performed at other hospitals.

Incisional hernia after surgical correction of abdominal congenital anomalies in infants: a systematic review with meta-analysis

“…In 3140 patients 188 incisional hernias occurred 15 – 64 . None of the studies reported on the mode of diagnosis or the size of the defect.…”

Divided and Separated Sigmoid Colostomy in Anorectal Malformation : Six Years Experience at Dhaka Shishu Hospital

“…A stoma in a mobile portion of the colon is more likely to prolapse than one in a fixed portion of the colon. 9 Oda et al found 2.8% patients had prolapse after divided colostomy. 4 Six(5.17%) patients in the present study developed prolapse of colostomy, among which all developed on distal stoma site.…”

“…Almosallam et al conducted a retrospective study to evaluate whether the type of colostomy has an impact on outcome in patients with ARM where they found 2.04% developed retraction of colostomy. 9 Oda et al compared clinical outcome of loop and divided colostomies performed as part of the surgical management of ARM where they found 4.2% developed retraction of colostomy. 4 Divided colostomy has a low risk of prolapse or retraction.…”

Loop colostomies are safe in anorectal malformations

“…The risk of prolapses was reported previously to be higher when a long period between formation and closure of loop colostomies [5]. However, this seems not always be related to the type of stoma since Almossalam et al published a series of 55 LCs and 49 DCs and did not find any difference between complications in the 2 groups regardless of the duration of stoma [4]. Our data have similarly demonstrated no difference in prolapse rates in those who had stoma closure within or after 6 months.…”

“…Colostomy is performed in staged surgery for ARM to relieve the intestinal obstruction and allow bowel decompression prior to definitive reconstruction. However, the ideal type of colostomy has been debated by pediatric surgeons [3][4][5][6][7][8]. A divided colostomy (DC) created at the junction of the descending and sigmoid colon has been recommended [2].…”