Loop versus divided colostomy for the management of anorectal malformations.
OBJECTIVE
The purpose of this study was to compare the clinical outcomes of loop and divided colostomies in patients with anorectal malformations (ARM).


METHODS
We 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.


RESULTS
One 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).


CONCLUSIONS
Because 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.
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Omar
O
Oda
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Dafydd
D
Davies
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
Kimberly
K
Colapinto
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: ted.gerstle@sickkids.ca.
J Ted
JT
Gerstle
D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008531:Megacolon / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011391:Prolapse; D012003:Rectal Fistula / Q000453:epidemiology / Q000209:etiology; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000453:epidemiology / Q000209:etiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology
Anorectal malformation; Divided colostomy; Loop colostomy