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Outcome of loop versus divided colostomy in the management of anorectal malformations
Osama Ibrahim Almosallam, Ali Aseeri, Saud Al Shanafey1
1Saud Al Shanafey, MD, MBC 40 Department of Surgery,, King Fasial Specialist Hospital and Research Center,, PO Box 3354 Riyadh 11211, Saudi Arabia, T: 966-11-442-7754, F: 966-11-442-7772, sashanafey@kfshrc.edu.sa, ORCID: http://orcid.org/0000-0002-9036-7564.
Insights
Loop colostomy is favored over divided colostomy for pediatric anorectal malformation (ARM) patients, offering shorter closure times and fewer complications. This study highlights loop colostomy as a potentially better surgical option for ARM management.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Colostomy is a standard procedure for managing high anorectal malformation (ARM) in children.
- The choice between loop and divided colostomy techniques is a critical surgical decision.
Purpose of the Study:
- To compare the outcomes of loop versus divided colostomy in pediatric patients with ARM.
- To identify any significant differences in morbidities associated with each colostomy type.
Main Methods:
- A retrospective analysis of pediatric ARM patients who underwent colostomy and definitive repair between 2000 and 2014.
- Comparison of outcomes, including operative time for closure and complication rates, between loop and divided colostomies.
Main Results:
- Loop colostomy closure was significantly faster than divided colostomy (76 vs. 94 minutes, P=.002).
- Divided colostomy was associated with more skin excoriation (17 vs. 10, P=.04) and instances of reversed orientation affecting bowel preparation.
- No significant differences in other creation and closure complications were observed between the two types.
Conclusions:
- Loop colostomy demonstrates a shorter operative time for closure and a lower incidence of skin excoriation compared to divided colostomy.
- The findings suggest that loop colostomy may be a more advantageous approach for ARM management in pediatric patients.
Background:
Colostomy is a common part of the management of high anorectal malformation (ARM) in the pediatric population.
Objective:
To evaluate whether the type of colostomy (loop vs divided) has an impact on outcome in patients with ARM.
Design:
A retrospective study.
Setting:
King Faisal Specialist Hospital and Research Center, a tertiary care center.
Patients And Methods:
All 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 Measures:
Morbidities associated with each type of colostomy.
Results:
There 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).
Conclusions:
Loop 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.
Limitations:
Retrospective nature of the study and some colostomies performed at other hospitals.
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