Classic divided sigmoidostomy vs loop sigmoidostomy in anorectal malformations: time for change?

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Divided sigmoidostomy (DS) is a traditional stoma technique for anorectal malformations (ARM).
• Loop sigmoidostomies (LS) are suggested to have increased risks of stoma prolapse and urinary tract infections (UTI) in ARM patients, though evidence is limited.

Purpose of the Study:

• To compare the outcomes of divided sigmoidostomy (DS) versus loop sigmoidostomies (LS) in patients with anorectal malformations (ARM).
• To evaluate complications, stoma function, and hospital stay associated with each surgical technique.

Main Methods:

• Retrospective analysis of ARM patients undergoing DS or LS between 2013 and 2023.
• Data collected included demographics, malformation type, surgical variables, complications (prolapse, UTI, wound issues), oral intake, stoma function, and hospital stay.

Main Results:

• 40 patients (29 DS, 11 LS) were analyzed; demographics and malformation types were comparable.
• Divided sigmoidostomy (DS) had significantly higher postoperative complications (48.3% vs 9.1%), primarily wound infections, dehiscences, and strictures.
• Loop sigmoidostomy (LS) showed shorter times to oral intake and stoma function, and reduced hospital stay (8 vs 36 days).
• Stoma prolapse and UTI rates were similar between DS and LS groups.

Conclusions:

• Loop sigmoidostomies (LS) do not present a higher risk of prolapse or UTI compared to divided sigmoidostomies (DS) in ARM patients.
• Divided sigmoidostomy (DS) is associated with a greater incidence of wound complications, including infections, strictures, and dehiscences, and longer hospitalizations.