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Comparing Loop and Divided Colostomy for Anorectal Malformation: A Systematic Review and Meta-Analysis
Gonca Gerçel1, Mustafa Azizoglu2, Esra Karakas3
1Istanbul Medeniyet University, Faculty of Medicine, Department of Pediatric Surgery, Istanbul, Türkiye; Pediatric Surgery Meta-Analysis Study Group (PeSMA), Türkiye.
Journal of Pediatric Surgery
|October 2, 2024
Summary
Loop colostomies (LC) and divided colostomies (DC) show similar outcomes for anorectal malformations (ARM) patients. This systematic review found no significant differences in complication rates between LC and DC, supporting both as viable fecal diversion options.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Optimal fecal diversion technique for anorectal malformations (ARM) remains debated.
- Loop colostomies (LC) and divided colostomies (DC) are common surgical options.
- Comparative clinical outcomes data are needed to guide surgical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze clinical outcomes comparing loop colostomies (LC) and divided colostomies (DC) in ARM patients.
- To evaluate the incidence of specific complications associated with each colostomy type.
Main Methods:
- Systematic review and meta-analysis of comparative studies on LC versus DC in ARM patients.
- Searched multiple databases and gray literature; registered on PROSPERO (CRD42024513335).
- Complications analyzed: stoma prolapse, UTI, skin excoriation, retraction, parastomal hernia, wound infection, and stricture.
- Meta-analysis performed using Revman 5.4; Level of Evidence II.
Main Results:
- Eleven studies included 2550 neonates (1147 LC, 1403 DC).
- No statistically significant differences found between LC and DC for stoma prolapse, UTIs, skin excoriation, stoma retraction, parastomal hernia, wound infection, or stoma stricture.
- All analyzed complication rates showed non-significant p-values (p > 0.05).
Conclusions:
- Loop colostomies (LC) and divided colostomies (DC) are comparable and viable options for fecal diversion in ARM.
- Both techniques present similar risks and benefits regarding common stoma-related complications.
- Surgical choice should be individualized based on patient factors and surgeon expertise.
