title: Loop versus divided colostomy for the management of anorectal malformations: a systematic review and meta-analysis.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  After 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.
  
  
  RESULTS
  Twenty-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.
  
  
  CONCLUSIONS
  A 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.
  
  
  METHODS
  3A.
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H4A 3J1.
authors.forename: Fouad
authors.initials: F
authors.lastname: Youssef
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H4A 3J1.
authors.forename: Ghaidaa
authors.initials: G
authors.lastname: Arbash
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H4A 3J1.
authors.forename: Pramod S
authors.initials: PS
authors.lastname: Puligandla
authors.affiliation: The Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada, H4A 3J1. Electronic address: robert.baird@mcgill.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Baird
mesh_terms: D000071056:Anorectal Malformations / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D006801:Humans; D015233:Models, Statistical; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Anorectal malformation; Divided; Loop; Meta-analysis; Systematic review