Divided Colostomy Research Articles

Five Years’ Single-center Experience of a Modified Approach to Divided Sigmoid Colostomy for Anorectal Malformation

BackgroundIn patients with anorectal malformation (ARM), a divided descending colostomy is associated with high complication rates, including wound infection, dehiscence, and prolapse, and it places a significant burden on caregivers. To decrease the chances of such complications, we modified our approach for colostomy fashioning by keeping an intact skin bridge between the colostomy and mucous fistula. The objective was to compare the rate of complications among patients diagnosed with ARM who underwent a modified divided descending colostomy and classical descending colostomy. MethodsWe included all the patients diagnosed with ARM who underwent a divided colostomy with modified (group A) or classical technique (group B) in the last 5 years. The type of approach used to fashion the stoma was based on the surgeon's preference than on patients' selection criteria. All patients were followed and monitored for postoperative complications. SPSS version 26 was used to analyze the data. ResultsA total of 62 patients with ARM underwent the colostomy creation; 27 in group A and 35 in group B. Males were more in both groups and other demographic variables were comparable. The most common associated anomalies were cardiac (58%). The mean duration of surgery was 72.2 ± 18.26 min in group A while 91.25 ± 21.43 min in group B (P = 0.000). The mean hospital stay was 4.28 ± 3.63 days in group A while 7.97 ± 6.12 days in group B (P = 0.007). The overall complication rate was 14.8% in group A and 34.2% in group B (P = 0.082). ConclusionThe modified approach to fashioning a divided colostomy is easily reproducible and carries a low risk of postoperative complications. Level of EvidenceIV.

Types and Levels of Colostomy in Children with Anorectal Malformation

Objective: Divided colostomy for anorectal management is often recommended due to reports of higher complications associated with loop colostomy. This study was conducted to compare outcomes and complications in colostomies in children with anorectal malformations according to type and level of colostomy.
 Materials and Methods: A retrospective study was performed in children with anorectal malformations who underwent a colostomy at Siriraj Hospital between December 2003 and June 2018.
 Results: Out of 167 patients, 159 had a loop colostomy while 8 had a divided colostomy. Overall complication rates were 33.3% for loop colostomy and 62.5% for divided colostomy (p = 0.100). Urinary tract infection was the most frequently encountered complication in both loop and divided colostomies, at 23.7% and 50%, respectively (p = 0.094). The prolapse rate in the loop colostomy group was 8.8 % and 0% in the divided colostomy group (p = 0.376). Overall complication rates with respect to location of stoma also did not differ (p = 0.706). Prolapse rates were 15.8 % in transverse colostomy and 7.1 % in sigmoid colostomy (p = 0.231). Overall complications rates of colostomy closure in loop and divided colostomy was 7.5% and 12.5%, respectively (p = 0.672). Non-inferiority was demonstrated by the differences in overall complications of loop and divided colostomy (p = 0.008).
 Conclusion: There was no difference in incidence of complications between type or location of colostomy performed in children with anorectal malformations. Loop colostomy was non-inferior to divided colostomy in respect to overall complications.

Factors Affecting the Neonatal Outcome with Anorectal Malformation in Underdeveloped Countries

Background: With optimal perioperative and postoperative care, the survival and outcomes of new-born with anorectal malformations (ARM) have improved significantly in developed countries, but sepsis, low birth weight, late presentation, and intense new-born care is still lacking in developing countries influencing the outcome. This analysis was conducted to assess aspects for poor outcomes (mortality) in new-born with anorectal malformations. Study Design: A prospective analytical study. Place and duration: In the Department of Paediatric Surgery at Divisional Headquarters Teaching Hospital Mirpur for six months duration from January 2021 to June 2021. Methods: 48 total consecutive neonates with anorectal malformations (ARMs) admitted to the Paediatric Surgery department were included. The studied variables comprised age at admission, birth weight, sex, type of malformation, sepsis at admission, type of surgery performed, postoperative issues, and their association with the results. Statistical analysis was executed with SPSS 21.0. Results: 48 neonates with ARM were enrolled in the study. 60.4% (29) of the research population are male neonates and 39.6% (19) are female neonates. 2.3 ± 0.7 days was the mean age at admission (minimum age was 1 day and the maximum 4 days) and 2.8 ± 0.9 kg was the mean body weight at birth (minimum weight was 1.7 kg, and the maximum weight was 4.5 kg). The communal reason of mortality in patients postoperative was sepsis (50%). There was a statistically significant correlation amid sepsis and low birth weight (p = <0.01) on admission (p = 0.002) with mortality. Comparing the result with age at the time of presentation (p = 0.19) and complications postoperatively (p = 0.18), no statistically significant correlation was found. Conclusions: Lack of trained midwives / LHV, Lack of resources, late admission, intensive care sepsis, and ultimately mortality are contributing factors in developing countries. Good prenatal care, awareness of midwives / community nurses to refer these patients on time, and adequate intensive care can improve the outcomes of ARM surgery. Keywords: Sepsis, Imperforate anus, low birth weight, primary PSARP, cloaca and Pelvic divided colostomy

Hirschsprung disease and imperforate anus without fistula in a 5-year-old boy with Trisomy 21

Hirschsprung disease (HD) and anorectal malformations (ARM) occur in approximately 1 in 5000 live births. These conditions are associated with Trisomy 21 but their co-existence in a single patient is exceedingly rare. A male infant was born at 36 weeks gestational age with Trisomy 21 and imperforate anus without fistula. He underwent divided colostomy, posterior sagittal anorectoplasty, and colostomy reversal as three separate procedures. Two weeks after colostomy reversal, the patient developed abdominal distention and difficulty feeding. He underwent laparotomy, lysis of adhesions, and strictureplasty at the site of the previous colostomy reversal, but continued to struggle with abdominal distension and poor weight gain. Contrast enema and colonoscopy performed at 5 years of age revealed a patent anastomosis with significant dilatation of the colon proximal to the anastomosis and collapsed distal colon. Full-thickness biopsy of the neorectum was consistent with HD. The patient then underwent transverse colectomy, levelling colostomy, and mucus fistula creation. He recovered well with improvement in weight gain and abdominal distension. HD and ARM may co-exist in children with Trisomy 21 and other genetic syndromes. Rectal biopsy should be considered prior to colostomy reversal in patients with ARM and Trisomy 21.

Comparison of frequency of complications in loop versus divided colostomy in patients with high variety anorectal malformation

Background: The objective of this study was to compare frequency of stoma related complications of loop versus divided sigmoid colostomy for the management of high variety anorectal malformations. Methodology: This RCT was conducted in the department of Pediatrics Surgery Department of the Children’s Hospital and the Institute of Child Health Lahore, for the period of one year from 1st May 2016 to 1st June 2017. One hundred and twenty patients (Sixty patients in each group) of anorectal malformation meeting inclusion criteria were taken in this study. Patients were divided into two groups randomly using lottery method; loop sigmoid colostomy in Group-A and divided sigmoid colostomy in Group-B. After surgeries patients were followed weekly up till 8 weeks. Stoma related complications (as per operational definition) were noted. Results: The mean age in group –A and group-B were 3.34 ± 1.12 days and 3.36 ± 0.97 days, respectively. In group – A there were 52(86.67%) male and 8(13.33%) females, and in group-B there were 45(75%) male and 15(25%) female patients. In group-A 22(36.66%) patients had complications [3(5.00%) patients had retraction, 8(13.33%) had prolapse, 4(6.67%) had stoma obstruction, parastomal hernia were seen in 4(6.67%), stoma necrosis were seen in 3 (5.00%)] and in group-B, 16(26.66%) patients had different complications [1(1.67%) patients had retraction, 3(5.00%) had prolapse, 5(8.33%) had stoma obstruction, parastomal hernia were seen in 2(3.3%), stoma necrosis were seen 5(8.33%)]. The complications in group-A were higher when compared to group-B, but (p-value = 0.650) were not significant statistically except for stoma prolapse. Conclusion: Though complication rate in both techniques is not statistically different but frequency of stoma prolapse is more in loop colostomy group. Therefore, divide colostomy should be opted as preferred technique.

The Outcome Of Loop Versus Devine's Colostomies In Management Of High Anorectal Malformations

The Outcome Of Loop Versus Devine's Colostomies In Management Of High Anorectal MalformationsAbstract:BACKGROUND: Colostomy is generally component of the neonatal population's management of high anorectal malformation (ARM). OBJECTIVES: To evaluate the outcome of loop colostomies in management of high ARM patients and compare it with Devine’s colostomies outcome. DESIGN: A case control retrospective prospective study. SETTING: pediatric surgery department, Zagazig university hospital. PATIENTS AND METHODS: All patients who were managed with colostomy for high ARM and had definitive repair during the period of January 2017 to January 2019. Outcomes relative to the type of the colostomy were compared. RESULTS: There were 30 patients managed for high ARM with colostomy as staged procedures, 17 males and 13 females. Patients had a colostomy at a median age of 2 days and were closed at a median of 9 months. Presence of fistula was in 18 patients. There were 15 loop and 15 divided colostomies. Operative time for loop colostomy creation was shorter than with divided colostomy (35 minutes vs 60 minutes, P=0.04). Operative time for loop colostomy closure was shorter than with divided colostomy (47 minutes vs 79 minutes, P=0.032).There was no differences in complications of creation of loop and divided colostomies, There was differences in complications of closure (p= 0.033).CONCLUSIONS: Loop colostomy has a shorter operating time of formation and closure and comparatively less complications compared to the separated colostomy. Our information suggest that loop colostomy may be more beneficial for high ARM patients than Devin's colostomy.

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

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.

Wound Dehiscence after Posterior Sagittal Anorectoplasty in Children with Anorectal Malformations.

Aim of the Study To assess the frequency of and identify contributing factors to wound dehiscence after posterior sagittal anorectoplasty (PSARP) in children born with anorectal malformations (ARM). Methods Ethical approval was obtained (DNR 2017/191). Charts of all children with anorectal malformations (ARM) reconstructed with PSARP, limited PSARP, or PSARVUP at a tertiary centre of paediatric surgery between 2001 and 2016 were reviewed. Wound dehiscence within 30 days postoperatively was analysed regarding gender, prematurity, birth weight, type of ARM, other congenital malformations, single- or multistaged reconstruction, age and weight at reconstruction, postoperative antibiotics, and fasting. Multiple regression analysis was performed for risk factors in single-stage PSARP or limited PSARP, presented as odds ratio (OR) with 95% confidence interval (CI). Main Results Ninety patients were included, of which 53 (59%) were males. Single-staged PSARP was performed in 40 (44%) patients and 50 (56%) had a multistaged reconstruction with a colostomy. Wound dehiscence was significantly more common among patients without a colostomy; 17 (43%) vs. 11 (22%) (p=0.043). In patients with single-stage PSARP, no single factor was identified to increase the risk for wound dehiscence: cardiac malformations (OR 3.73) (95% CI 0.78-17.88), low weight at surgery (OR 1.56) (95% CI 0.36-6.99), antibiotics < 1 day (OR 1.6) (95% CI 0.43-5.94), or short fasting 0-3 days (OR 4.44) (95% CI 0.47-42.18). Conclusions A divided colostomy protected against wound dehiscence after PSARP. No risk factor for wound dehiscence after single-staged PSARP was identified. Further studies are needed to establish contributing factors to uncomplicated wound healing after PSARP.

Loop colostomies are safe in anorectal malformations

Aim of the studyDivided colostomy (DC) has been recommended in anorectal malformations (ARMs) with previously reported advantages of decreasing overflow into the distal limb and urinary tract infections (UTIs). Skin bridge loop colostomy (LC) is a technically easier alternative without an increase in these complications. We report our institutional experience of LC in ARM. MethodsRetrospective study (Institution-approved Clinical Audit) reviewing the clinical records of all patients with ARM undergoing stoma formation in a single UK tertiary pediatric surgical center (2000–2015). Data collected included type of ARM, associated anomalies, type and level of colostomy, time to stoma closure, complications and UTIs. ResultsOne hundred and eighty-two (95 female) patients underwent colostomy formation for ARM. The vast majority (171/ 94%) underwent LC; 9 (5%) had a divided colostomy (DC) and 2 (1%) had no available data. The spectrum of defects in girls included rectovestibular (62/65%), rectovaginal (4/4%) and cloaca (29/31%). In boys, 71 (82%) had a fistula to the urinary tract and 16 (18%) presented with a perineal fistula. Urological abnormalities coexisted in 87 (47.8%) patients. Thirty five (21%) patients developed UTIs. Among the 19 girls who developed UTI, 8 had rectovestibular fistula and 11 had cloaca. Of the 16 boys who developed UTI, 14 had a fistula to the urinary tract and 11 had an independent urological abnormality. The mean time from stoma formation to stoma closure was 10 (3–52) months. Complications were reported in 22 (12%) LCs. Fifteen patients (9%) developed a stoma prolapse following LC with 10 (6%) requiring surgical revision. ConclusionsThis is the largest reported series of outcomes following LC for ARM. LC is easier to perform and to close, requiring minimal surgical access, with comparable complications and outcomes to those published for DC. Type of studyRetrospective comparative study. Level of evidenceIII.

Loop versus divided colostomy for the management of anorectal malformations: a systematic review and meta-analysis

BackgroundThe ideal colostomy type for patients with anorectal malformations (ARM) is undetermined. We performed a systematic review and meta-analysis of short-term complications comparing loop and divided colostomies. MethodsAfter review registration (PROSPERO: CRD42016036481), multiple databases were searched for comparative studies without language or date restrictions. Gray literature was sought. Complications investigated included stomal prolapse/hernia/retraction, wound infections, and urinary tract infections (UTIs). Two reviewers independently assessed study eligibility and the quality of included studies. Meta-analysis of selected complications was performed using Revman 5.3, with p<0.05 considered significant. ResultsTwenty-six studies were included, and four were multi-institutional. Reporting standards were highly variable. Studies scored between 6 and 9 of possible nine stars on the NOS. Overall, 3866 neonates with ARM were incorporated, in which 2241 loop colostomies and 1994 divided colostomies were reported. Of 10 studies reporting short-term complications, the overall rate was 27%. Meta-analysis demonstrated no significant difference in the incidence of UTIs, (OR: 2.55 [0.76, 8.58], p=0.12), while loop colostomies had a significantly higher prolapse rate (See figure). No publication bias was noted. ConclusionsA colostomy for patients with an ARM is a source of considerable morbidity. Divided colostomies reduce the risk of subsequent prolapse and may represent the preferred approach. Level of evidence3A

The currarino syndrome presenting as neonatal intestinal obstruction in a Nigerian male child

We describe the first documented radiologic findings of complete Currarino triad presenting as neonatal intestinal obstruction in a Nigerian male child. A 1-week-old male neonate was admitted for rectal agenesis and had a divided colostomy during which an anterior sacral meningocele was discovered intraoperatively. The imaging evaluation revealed further, the triad of a partial sacral defect, anorectal atresia, and anterior sacral meningocele. These radiologic findings define the rare association known as the Currarino syndrome (CS). The CS expresses a wide phenotypic expression, and so its diagnosis may be elusive. This case emphasizes the need for physicians to be cognizant of the clinical presentation and radiologic findings of CS. It is a triad to remember in infants with anorectal malformations and even older children or adults presenting with chronic constipation.

The morbidity of a divided stoma compared to a loop colostomy in patients with anorectal malformation

PurposeLoop colostomies may contaminate the genitourinary (GU) tract in patients with anorectal malformations (ARM) owing to incomplete diversion of stool. Stoma complications are also thought to be higher with a loop versus divided colostomy. We sought to compare the morbidity, including urinary tract infections (UTI), in these two types of colostomies in children with ARM. MethodsA review was performed at a children's hospital (1989–2014). Children with ARM who had a colostomy performed were identified. Demographic data and outcome variables were collected. Analyses included Student's t-test, Fischer's exact and logistic regression as appropriate. Results171 patients were identified (loop=78; divided=93). Thirty percent of patients with a divided colostomy and 24% with a loop experienced a stoma complication (p=0.5). A subgroup analysis of children with a rectourinary fistula (54 divided, 26 loop) was performed to assess for effect of colostomy type on UTI. After controlling for other UTI risk factors (major GU anomalies, vesicostomy, and prophylactic antibiotics), loop ostomies were not associated with risk of UTI (OR 0.83, 95% CI 0.27–2.63). No patient with a loop colostomy developed megarectum. ConclusionsChildren with ARM who undergo a loop colostomy are not at a detectable increased risk of experiencing a UTI compared to a divided stoma. The rate of stoma complication is high regardless of the type of stoma created.

Postoperative megarectum in an adult patient with imperforate anus and rectourethral fistula.

This report presents a surgical case of postoperative megarectum in an adult patient with imperforate anus/anorectal malformations. A 71-year-old Japanese male presented with a mass in the lower abdomen which was 15 × 12 × 8 cm in diameter, edema in the right lower extremity, and frequent urination. He had undergone sigmoid loop colostomy for an imperforate anus as a newborn infant. At 28 years of age, the sigmoid loop colostomy was changed to sigmoid divided colostomy in the left lower abdomen. Computed tomography revealed a large cystic mass in the lower abdomen. Retrograde urethrography indicated a rectourethral fistula and megarectum with stones. A small laparotomy incision was created in the right lower abdomen, and the wall of the megarectum was identified. Approximately 2,300 mL of gray muddy fluid was identified and drained. A mucous fistula of the upper rectum was created in the right lower abdomen. This is an extremely rare case of postoperative megarectum in an adult patient with an imperforate anus and rectourethral fistula.

Cloaca and hydrocolpos: laparoscopic-, cystoscopic- and colposcopic-assisted vaginostomy tube placement

Hydrocolpos presenting at birth in a neonate with a cloacal malformation may lead to massive distension, with compression of adjacent structures. At times, the hydrocolpos requires urgent drainage. Additionally, these neonates need a divided colostomy to divert their fecal stream and prevent genitourinary contamination. We present a novel approach by which these two procedures can be performed as a single operation guided by a combination of cystoscopy, colposcopy, and laparoscopy. This provides a minimally invasive technique with excellent outcome and potentially superior visualization of the necessary intra-abdominal structures.

Colonic duplication with recto-urethral fistula: Elusive diagnosis and successful treatment in a resource-limited setting

A 3-year-old Ugandan boy presented with 18 months of constipation and 12 months of pneumaturia and fecaluria. Physical exam revealed abdominal distension and a palpable mass anterior to the rectum. Previous contrast enema had been non-diagnostic, and a voiding cystourethrogram (VCUG) had confirmed a recto-urethral fistula. After surgical evaluation, a computed tomography (CT) scan suggested colonic duplication, and a laparotomy was performed for rapidly progressive bowel obstruction. A tubular colonic duplication with fecal impaction was found, necessitating fecal disimpaction and a double divided colostomy. Two months later at re-laparotomy, the septum between the duplicated colonic lumens was found to extend proximally to the mid transverse colon and distally to the upper rectum, and was divided. No urethral fistula was identified, and the colostomy was recreated. At a third operation, the colostomy was reversed. The patient is well at one-year follow up, without evidence of recurrent fistula or stricture. This case shows that colonic duplication in children can be an elusive diagnosis. Often, a variety of radiographic studies may be needed and may be difficult to interpret. In cases with colo-urinary fistula, the fistula may respond to fecal diversion without requiring operative repair. Management in a resource-limited setting can still yield positive outcome. • Colonic duplication in children can be an elusive diagnosis. • A variety of radiographic studies may be needed and may be difficult to interpret. • Colo-urinary fistula may respond to fecal diversion without requiring operative repair. • Management in a resource-limited setting can still yield positive outcome.

Loop versus divided colostomy for the management of anorectal malformations

PurposeThe purpose of this study was to compare the clinical outcomes of loop and divided colostomies in patients with anorectal malformations (ARM). MethodsWe performed a retrospective cohort study reviewing the medical records of all patients with ARM managed with diverting colostomies between 2000 and 2010 at our institution. Independent variables and outcomes of stoma complications were analyzed by parametric measures and logistic regression. ResultsOne hundred forty-four patients managed with a colostomy for ARM were evaluated (37.5% females, 50.7% loop, 49.3% divided). The incidence of patients with loop and divided colostomies who developed stoma-related complications was 31.5 and 15.5%, respectively (p=0.031). The incidence of prolapse was 17.8 and 2.8%, respectively (p=0.005). Multivariable-logistic regression controlling for other significant independent variables found loop colostomies to be positively associated with the development of a stoma complication (OR 3.13, 95%CI (1.09, 8.96), p=0.033). When individual complications were evaluated, it was only stoma prolapse that was more likely in patients with loop colostomies (OR 8.75, 95%CI (1.74, 44.16), p=0.009). ConclusionBecause of the higher incidence of prolapse, loop colostomies were found to be associated with a higher total incidence of complications than divided stomas. The development of other complications, including urinary tract infections (UTIs) and megarectum, were independent of the type of colostomy performed.

Rectal obstruction by a giant pharmacobezoar composed of magnesium oxide: Report of a case

This report presents the rare case of a 75-year-old woman who developed a rectal obstruction caused by a pharmacobezoar, following the long-term ingestion of magnesium oxide cathartics for constipation. She was admitted to the hospital with lower abdominal pain and nausea. Abdominal computed tomography and magnetic resonance imaging showed that a huge calcified mass caused the rectal obstruction. A divided sigmoid colostomy was performed to relieve her symptoms, a colonoscopy from the distal stoma delineated a huge bezoar in the rectum, and thereafter she underwent an enterotomy. Magnesium oxide was detected in an analysis of a sample from this bezoar. Phamacobezoars resulting from laxatives or cathartics have rarely been reported. The current report showed a rectal obstruction caused by a pharmacobezoar composed primarily of magnesium oxide.

The treatment of high and intermediate anorectal malformations: One stage or three procedures?

Background/Purpose The aim of this study was to examine the safety, feasibility, and the long-term outcome of complete 1-stage repair of high and intermediate anorectal malformation using posterior sagittal anorectoplasty (PSARP) in a neonate. Methods One hundred thirteen patients with high-type and intermediate-type anorectal malformations (ARM) underwent follow-up. Of 113 cases, 48 cases entailed a divided colostomy, definitive operation, and colostomy closure (group I); the other 65 patients underwent 1-stage PSARP (group II). Anorectal function was measured by the modified Wingspread scoring, including “excellent,” “good,” “fair,” and “poor.” In barium enema studies, anorectal angulation was judged as “clear,” “unclear,” and “not present,” and leakage of barium was observed in the meantime. For anorectal manometric studies, anal resting pressure (ARP), anal squeezing pressure (ASP), and positive anorectal reflex (PAR) were measured. Results In group I, the rate of excellent and good scores was 58.3% (28 of 48). In the barium enema examination, 85.4% (41 of 48) was clear and 14.6%(7 of 48) unclear or not present. The rate of barium leakage was 10.4% (5 of 48). In group II, the rate of excellent and good was 53.8% (35 of 65). Anorectal angulations were clear in 83.1% of patients (54 of 65). Barium leakage happened in 7.69% of patients (5 of 65). Early operative complications occurred in 56.3% (27 of 48) of patients in group I and 29.2% (19 of 65) in group II. The incidence of colostomy complications in group I was 39.6% (19 of 48). Soiling and constipation were the major complications after the PSARP operation. The respective rates of constipation in the 2 groups were 47.9% (23 of 48) and 44.6% (29 of 65), and the respective rates of soiling were 47.9% (23 of 48) and 50.8% (33 of 65). There was no significant difference in the mean ARP between the 2 groups. Conclusions The 1-stage PSARP procedure in the neonate not only achieves the same long-term outcome as the conventional PSARP procedure but also involves fewer short-term complications. Complete 1-stage repair using the PSARP to treat high-type and intermediate-type anorectal malformations is safe and feasible.

An audit of neonatal colostomy for high anorectal malformation: the developing world perspective.

A high divided sigmoid colostomy has been recommended for staged management of high anorectal malformation. We audited our cases of neonatal colostomy for high anorectal malformation to assess its effectiveness. A retrospective study was carried out of all surgical newborns admitted with high imperforate anus as the single diagnosis at our centre between December 1998 and December 2000. Morbidity and mortality were analysed after retrospective stratification into two groups (group A: birth weight >2.5 kg; group B: birth weight <2.5 kg). The chi square test was used to test the statistical significance in terms of outcome in the two groups. Overall mortality was 16%. Group A consisted of 34 babies: 30 with divided sigmoid colostomy and four with transverse loop colostomy. One baby with a divided sigmoid colostomy died from wound complications and septicaemia (mortality 2.9%). All four babies with transverse loop colostomy done under local anaesthesia survived, despite being sick on arrival. Group B consisted of 16 babies: 15 with sigmoid colostomy and one with transverse loop colostomy, with seven deaths (44%). None of the five babies with transverse loop colostomy done under local anaesthesia died, despite being sick on arrival, whereas all eight babies who died had undergone sigmoid colostomy under general anaesthesia. The difference in the outcomes of babies in groups A and B is highly significant ( p <.01). Sick, small (<2.5 kg) and septic babies arriving late to the unit do not appear to tolerate general anaesthesia and divided sigmoid colostomy well, despite that procedure's long-term advantages. Divided sigmoid colostomy has produced excellent results in babies >2.5 kg, but in the context of the developing world and limited critical care availability, transverse loop colostomy under local anaesthesia may save lives.

Anorectal carcinoma involving the female genital tract: the morbidity and implications for sexual function

Background: Carcinoma of the colon and anorectum affect a younger age group in Africans, and patients often present late with advanced disease. Method: A retrospective review of 22 females treated for anorectal carcinoma. Results: Fourteen females had genital tract involvement; their mean age was 33.8 years. Thirteen patients had abdominoperineal resection. The other patient had a divided colostomy. Adjuvant chemotherapy was given to 12 patients. Wound infection occurred in 3 patients, and wound dehiscence in one patient. Five patients resumed sexual activity 6 months after surgery. One patient died of pneumonia 23 days after surgery. Conclusion: Anerectal carcinoma causes morbidity related to the genital tract and sexual function in females. (Nig J Surg Res 2003; 5: 38 – 42) Key words: Anorectum, carcinoma, female, sexual function