title: Outcome of loop versus divided colostomy in the management of anorectal malformations.
abstract: BACKGROUND
  Colostomy is a common part of the management of high anorectal malformation (ARM) in the pediatric population.
  
  
  OBJECTIVE
  To evaluate whether the type of colostomy (loop vs divided) has an impact on outcome in patients with ARM.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  King Faisal Specialist Hospital and Research Center, a tertiary care center.
  
  
  METHODS
  All patients who were managed with colostomy for ARM and had definitive repair during the period of January 2000 to December 2014. Outcomes relative to the type of the colostomy were compared.
  
  
  METHODS
  Morbidities associated with each type of colostomy.
  
  
  RESULTS
  There were 104 patients managed for ARM with colostomy as staged procedures, 63 males and 41 females. Patients had a colostomy at a median age of 6 days and were closed at a median of 11 months. Definitive repair was at a median age of 17 months. Type of fistula was 8 perineal, 21 rectovestibular, 35 rectourethral, 11 rectovesical and there were 16 without fistula and 13 cloaca anomalies. There were 55 loop and 49 divided colostomies. There were 91 descending/sigmoid and 13 transverse colostomies. Operative time for loop colostomy closure was shorter than with divided colo6stomy (76 minutes vs 94 minutes, P=.002). Three patients among the divided group had reversed orientation of the colostomy that had affected bowel preparations negatively prior to its repair. There was no differences in complications of creation and closure of loop and divided colostomies except in occurrence of skin excoriation. There was more skin excoriation with divided colostomy compared to loop colostomy (17 vs 10, P=.04).
  
  
  CONCLUSIONS
  Loop colostomy has a shorter closure operative time and relatively fewer complications compared to the divided colostomy. Our data suggests that loop colostomy may be more favorable than divided colostomy for ARM patients.
  
  
  CONCLUSIONS
  Retrospective nature of the study and some colostomies performed at other hospitals.
authors.forename: Osama Ibrahim
authors.initials: OI
authors.lastname: Almosallam
authors.forename: Ali
authors.initials: A
authors.lastname: Aseeri
authors.affiliation: Saud Al Shanafey, MD, MBC 40 Department of Surgery,, King Fasial Specialist Hospital and Research Center,, PO Box 3354 Riyadh 11211, Saudi Arabia, T: 966-11-442-7754, F: 966-11-442-7772, sashanafey@kfshrc.edu.sa, ORCID: http://orcid.org/0000-0002-9036-7564.
authors.forename: Saud Al
authors.initials: SA
authors.lastname: Shanafey
mesh_terms: D000071056:Anorectal Malformations / Q000601:surgery*; D044683:Colon, Descending / Q000601:surgery; D012809:Colon, Sigmoid / Q000601:surgery; D044684:Colon, Transverse / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012867:Skin / Q000293:injuries; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology