Loop versus Divided Colostomy in Patients with High and Intermediate Anorectal Malformations: Randomized Controlled Study

Abstract

Background: Colostomy is performed as a step of staged management of high-type anorectal malformations in pediatrics. Creating a colostomy, by itself, is a minor surgical procedure, but it has many complications. Aim: The aim of the study was to compare the outcome results of loop versus divided colostomies in patients with high and intermediate anorectal malformations. Methods and Material: This randomized prospective study was performed on 34 patients with imperforate anus. Patients were divided into 2 groups (17 patients each); group A were subjected to loop colostomy and group B were subjected to divided colostomy. Results: There was no significant difference between both groups as regards to demographic data (gestational age, sex and birth weight), age of first presentation, associated congenital anomalies and types of fistula. The mean operative time was 42.05 ±6.19 min in group A and 51.76 ±8.21 min in group B. The difference between both groups in this point was statistically significant (P value =0.04). The hospital stay and postoperative complications showed insignificant difference between both groups. Patients with loop stomas were significantly more likely to develop prolapse (P=0.033). Conclusions: Both techniques of colostomy are easy to perform and safe in the anorectal malformation (ARM) patients. Loop colostomy had a shorter operative time, but the complications rates, especially prolapse and urinary tract infection (in cloaca patients), are significantly higher in the loop colostomy when compared to the divided colostomy.