Early Feeding and Shortened Hospital Stay after Colostomy Takedown in Patients with Imperforate Anus

Abstract

Objective: This study reviewed 15 years of experience with 94 patients to identify an optimal feeding protocol and hospitalization plan for patients with imperforate anus who underwent colostomy takedown. Methods: The authors treated 145 patients with imperforate anus from June 1988 to August 2003. Among them, 94 underwent a 3-stage operation (colostomy, posterior sagittal anorectoplasty, and colostomy takedown). Traditionally, patients started feeding on the 2(superscript nd) or 3(superscript rd) postoperative day (POD) and went home on the 5(superscript th) or 6(superscript th) POD (n=10). In 1991, the authors adopted a protocol in which patients received feeding on the 1(superscript st) POD and were discharged on the 2(superscript nd) POD (n=21). Then, in 1994, a more aggressive protocol permitted feeding 6 hours after colostomy takedown. However, one patient suffered an anastomotic leak, which subsided three days later after abstinence from feeding. Thus the 1(superscript st) POD feeding protocol was resumed in 1995 and 59 more patients were added to the 1991 program. Results: Of the 80 patients following the 1991 protocol, feeding started at 20.2 hours (range 17.4-41.5), and the mean postoperative hospital stay was 1.9 days (range 1.7-3.2). Three patients encountered minor complications but recovered after conservative treatment. Of the 4 patients following the 1994 protocol, one suffered anastomotic leakage. Conclusion: Our 1(superscript st) POD feeding and 2(superscript nd) POD discharge plan is safe and efficient for patients with imperforate anus who undergo colostomy takedown.