title: Ostomy complicatıons in patients with anorectal malformations.
abstract: OBJECTIVE
  Ostomy is an important step in the treatment of patients with anorectal malformation (ARM). Sometimes this basic surgical procedure may cause a devastating complication.
  
  
  METHODS
  The medical reports of the patients with ARM who had ostomy in the past were inspected. How many of them were operated in this center or sent from others, the type of ARM, what type of ostomy performed and which place of the bowel used and the complication type and rate related to ostomy and ostomy closure were evaluated.
  
  
  RESULTS
  Nearly, 157 of 230 patients with ARM had ostomy during twenty-two years were evaluated. The prevelent type of ostomy was loop (50.3%) and then separated (36.9%), end (7%), double barrel (4.4%) and window (1.2%). The ostomies were located in the tranverse colon (53.5%), descending colon (24.2%), sigmoid colon (17.8), pouch colon (2.5%) and ileum (1.9). Total complication rate was found to be 15.2% (24/157) (window 100%, double barrel 42.8%, separated 15.5%, loop 11.3%, end 9%). The main complication of loop ostomies was prolapse whereas wound problems, stenosis, intestinal obstruction or perforation were serious problems of separated ostomies. Complication rate in the descending colon and tranverse colon was found to be 7.1 and 28%, respectively (p = 0.001). Any difference for complication rate between loop and separated ostomies was not found. Eighteen of separated ostomies had mucous fistula and six of them (33%) were complicated, this rate was higher than those without mucous fistula (p = 0.012). Two babies with separated ostomy were lost due to surgical complications (1.2%). Complication rate after ostomy closure was 10.7% [wound infection (4.4%), intestinal obstruction (1.7%)].
  
  
  CONCLUSIONS
  According to this study, ostomy performed in the descending colon carries greater risks for complication regardless of its type. Nevertheless, separated ostomy with mucous fistula should be performed by experienced hands.
authors.affiliation: Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey. billurd@yahoo.com
authors.forename: Billur
authors.initials: B
authors.lastname: Demirogullari
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Yilmaz
authors.forename: Gulsen Ekingen
authors.initials: GE
authors.lastname: Yildiz
authors.forename: I O
authors.initials: IO
authors.lastname: Ozen
authors.forename: Ramazan
authors.initials: R
authors.lastname: Karabulut
authors.forename: Zafer
authors.initials: Z
authors.lastname: Turkyilmaz
authors.forename: Kaan
authors.initials: K
authors.lastname: Sonmez
authors.forename: A Can
authors.initials: AC
authors.lastname: Basaklar
authors.forename: Nuri
authors.initials: N
authors.lastname: Kale
mesh_terms: D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D004766:Enterostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D014421:Turkey