The morbidity of a divided stoma compared to a loop colostomy in patients with anorectal malformation

Liechty, Shawn; Barnhart, Douglas C.; Huber, Jordan; Zobell, Sarah; Rollins, Michael D.

doi:10.1016/j.jpedsurg.2015.10.025

Cited by 28 publications

(18 citation statements)

References 6 publications

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“…Interestingly, recent studies have indicated that loop stomas do not necessarily confer an increased risk of urinary infection than divided stomas. [14] Despite precautions and rectourinary disconnection at anorectoplasty, a quarter of patients had ureteral and urethral issues that complicated the course and prompted additional surgical interventions to arrest urinary infections and preserve renal function.…”

Section: Discussionmentioning

confidence: 99%

Solitary functioning kidney in high anorectal malformation

Das

Rajkiran

2017

J Indian Assoc Pediatr Surg

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Aim:A solitary functioning renal unit in high anorectal malformation may harbor anomalies in the upper/lower urinary tract that further compromise renal function and accelerate hyperfiltration injury. We aimed to analyze the clinical course, management, and outcome of children with a solitary renal unit and high anorectal malformation.Materials and Methods:A cohort of solitary renal units in anorectal malformation managed between 2000 and 2015 with a defined protocol at a pediatric nephro-urology clinic are included in the study. Investigations and management were individualized according to issues in the agenetic/dysplastic unit, solitary functioning unit, or bladder-urethra. Clinical details, management, and outcome were analyzed.Results:Of 53 cases of high anorectal malformation with urologic anomalies, 17 (32%) had single kidneys. Majority (10/17, 59%) had another complicating urinary tract anomaly, four being uremic at presentation. Nearly half had multiple urinary infections including epididymo-orchitis unrelated to the rectourinary fistula and warranted additional stoma (bowel/urinary) or other urinary tract surgery. At a mean follow-up of 70 months, majority (14/17, 82%) have a preserved solitary renoureteric unit while the remaining three await renal replacement therapy.Conclusion:Solitary functioning renal units associated with high anorectal malformation in children need meticulous investigation and surveillance to facilitate renal preservation. The implications of the associated rectourinary fistula, vesicoureteral reflux, urinary infections including epididymo-orchitis, and other urinary tract anomalies on the conventional surgical management are illustrated.

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Section: Discussionmentioning

confidence: 99%

Solitary functioning kidney in high anorectal malformation

Das

Rajkiran

2017

J Indian Assoc Pediatr Surg

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“…One study performed in a subgroup analysis of patients with a rectourinary fistula controlled for other risk factors, yet found no difference in urinary tract infection. 11 …”

Section: Discussionmentioning

confidence: 99%

Outcome of loop versus divided colostomy in the management of anorectal malformations

Almosallam

Aseeri

Shanafey

2016

Annals of Saudi Medicine

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BACKGROUNDColostomy is a common part of the management of high anorectal malformation (ARM) in the pediatric population.OBJECTIVETo evaluate whether the type of colostomy (loop vs divided) has an impact on outcome in patients with ARM.DESIGNA retrospective study.SETTINGKing Faisal Specialist Hospital and Research Center, a tertiary care center.PATIENTS AND METHODSAll 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.MAIN OUTCOME MEASURESMorbidities associated with each type of colostomy.RESULTSThere 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).CONCLUSIONSLoop 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.LIMITATIONSRetrospective nature of the study and some colostomies performed at other hospitals.

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“…2,18,19 The complication rate associated with a neonatal colostomy is high, and it has been reported between 23 and 30%. 20,21 The main complications are wound dehiscence, prolapse, intestinal obstruction, skin rash, and bleeding. In developing countries, colostomy formation for anorectal malformations was associated with significantly high mortality (11.5%) and surgical site infection (19.7%) rates.…”

Section: Comparison With Other Literaturementioning

confidence: 99%

Outcomes of Primary versus Multiple-Staged Repair in Hirschsprung's Disease in England

et al. 2020

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Introduction The study aimed to compare 1-year outcomes for primary versus multiple-staged (three operations with colostomy) repairs in Hirschsprung's disease (HD). Materials and Methods Retrospective analysis of a large national administrative database (Hospital Episode Statistics) including all the neonates born with HD in England between 2003 and 2015. Main outcomes were: 1-year mortality, postoperative readmissions, and reoperations. Secondary outcomes: cumulative length of hospital stay (cLOS) and hospital volume–outcome relationship. Results A total of 1,333 neonates with HD were treated in 21 specialist pediatric surgical centers; 874 (65.5%) patients had a primary repair for HD. One-year mortality was 2.8%. The overall readmission rate was 70.2%, with a significant difference between primary and multiple-staged repair (79.9 vs. 90.1%, p < 0.01). There was no difference in reoperation. Primary pull-through was associated with a significantly lower probability of postoperative readmission (odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.06–0.11, p < 0.001) and cLOS (OR = 0.38, 95% CI = 0.28–0.52, p < 0.001) compared with multiple-staged repair. There were no significant difference in outcomes between patients treated in low-volume (<37 cases/year) and high-volume (> 55 cases/year) specialist centers. Conclusion Whenever clinically indicated, primary repair should be used in HD as this is associated with fewer readmissions and shorter time spent in the hospital.

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The morbidity of a divided stoma compared to a loop colostomy in patients with anorectal malformation

Cited by 28 publications

References 6 publications

Solitary functioning kidney in high anorectal malformation

Solitary functioning kidney in high anorectal malformation

Outcome of loop versus divided colostomy in the management of anorectal malformations

Outcomes of Primary versus Multiple-Staged Repair in Hirschsprung's Disease in England

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