title: The morbidity of a divided stoma compared to a loop colostomy in patients with anorectal malformation.
abstract: OBJECTIVE
  Loop 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  171 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.
  
  
  CONCLUSIONS
  Children 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.
authors.affiliation: Primary Children's Hospital, University of Utah, Salt Lake City, UT.
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Liechty
authors.affiliation: Primary Children's Hospital, University of Utah, Salt Lake City, UT.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.affiliation: Primary Children's Hospital, University of Utah, Salt Lake City, UT.
authors.forename: Jordan T
authors.initials: JT
authors.lastname: Huber
authors.affiliation: Primary Children's Hospital, University of Utah, Salt Lake City, UT.
authors.forename: Sarah
authors.initials: S
authors.lastname: Zobell
authors.affiliation: Primary Children's Hospital, University of Utah, Salt Lake City, UT. Electronic address: michael.rollins@imail2.org.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Rollins
mesh_terms: D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012003:Rectal Fistula / Q000209:etiology; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects*; D014548:Urinary Fistula / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology*
keywords: Anorectal malformation; Colostomy complications; Divided colostomy; Imperforate anus; Infection; Loop colostomy; Mucous fistula