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Colostomy type in anorectal malformations: 10-years experience
S Gardikis1, S Antypas, C Mamoulakis
1Department of Pediatric Surgery, Democritus University of Thrace, Medical School, Alexandroupolis, Greece. sgardik@med.duth.gr
Insights
Loop colostomy in infants with anorectal malformations is linked to higher complication rates. Early corrective surgery or switching to separated-stomas colostomy before posterior sagittal anorectoplasty can reduce these risks.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Anorectal Malformations
Background:
- Anorectal malformations (ARMs) often necessitate colostomy in infants.
- The type of colostomy and timing of definitive surgery may impact patient outcomes.
- Complications associated with colostomy can affect morbidity in ARM treatment.
Purpose of the Study:
- To evaluate the influence of different colostomy types on morbidity in infants with ARM.
- To compare complication rates between loop colostomy and separated-stomas colostomy.
- To assess the impact of surgical timing on outcomes.
Main Methods:
- Retrospective analysis of 68 infants with ARM treated between 1991-2001.
- Patients were divided into three groups based on colostomy type and timing of posterior sagittal anorectoplasty (PSARP).
- Statistical comparison of complication incidence using the 2-sided Fisher's exact test.
Main Results:
- Loop colostomy (Group A) had a significantly higher incidence of complications (stoma prolapse, wound infection, dehiscence, stricture) compared to separated-stomas colostomy (Group C) and early loop colostomy (Group B).
- Complication rates between early loop colostomy (Group B) and separated-stomas colostomy (Group C) were not significantly different.
- After excluding colostomy prolapse cases, loop colostomy still showed significantly higher complication rates than separated-stomas colostomy.
Conclusions:
- Loop colostomy performed early is associated with increased morbidity, particularly when definitive surgery is delayed.
- Separated-stomas colostomy or early corrective procedures are recommended to minimize complications before PSARP.
- Optimizing colostomy management is crucial for improving surgical outcomes in ARM treatment.
Aim:
The aim of this study was to evaluate the influence of colostomy type on morbidity during the treatment of anorectal malformations.
Methods:
Sixty-eight infants (male: female ratio 1.3:1) with anorectal malformations that required colostomy were treated in our clinics during the period 1991-2001. Of these patients, 26 had received a loop colostomy: 14 of these underwent posterior sagittal anorectoplasty (PSARP) at the age of 9-12 months (Group A), and 12 underwent PSARP at the age of 2-4 months (Group B). Forty-two infants received a separated-stomas colostomy and underwent PSARP at the age of 9-12 months (Group C). The incidence of complications among groups was compared using the 2 sided Fisher's exact test.
Results:
Eight cases from group A were complicated with prolapse of the stomas, perianal wound infection, pull-through dehiscence, and anal fibrotic stricture. The only complication observed in groups B and C was perianal wound infection, which occurred in 1 case from each group. A statistically significant difference was observed in the incidence of complication between groups A and C (p<0.001) and between groups A and B (p=0.014). The results from groups B and C did not differ significantly (p=0.398). When the cases complicated with colostomy prolapse were removed from the statistical analysis, groups A and C still differed significantly (p=0.001) but groups A and B did not (p=0.069).
Conclusions:
As the incidence of complications increases with time after a loop colostomy, we encourage either an early corrective procedure or the modification into separated-stomas colostomy (SSC) before PSARP is performed for those cases that would involve definitive surgery in late infancy.
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