Treating pediatric colorectal patients in low and middle income settings: Creative adaptation to the resources available

Brisighelli, Giulia; Etwire, Victor; Lawal, Taiwo Akeem; Arnold, Marion; Westgarth-Taylor, Chris

doi:10.1016/j.sempedsurg.2020.150989

Cited by 7 publications

(2 citation statements)

References 65 publications

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“…We postulate that the presence of a suture line between the proximal and distal stomas contributes to the augmented risk of wound sepsis associated with divided stomas. Other factors, such as compromised nutritional status, HIV-exposure, and limited availability of nursing care, may further heighten the vulnerability of these children to wound breakdown, thus favoring the use of end stomas as a preventive measure [9,10,[15][16][17]. Adhesive small bowel obstruction was signi cantly more frequent in patients with end stomas compared to those with divided stomas.…”

Section: Discussionmentioning

confidence: 99%

“…In LMIC complications rates after stoma formation are higher compared to HIC, with peristomal excoriation and wound sepsis being the most frequently reported complication [14]. This is probably related to multiple factors with delayed diagnosis, HIV-exposure incidence, malnutrition, lack of trained stoma nurses, and poverty, being the most relevant ones [8,15].…”

Section: Discussionmentioning

confidence: 99%

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Are end colostomies always contraindicated in anorectal malformations?

Brisighelli,

Theron,

Westgarth-Taylor

et al. 2023

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Purpose In our clinical setting, a three-staged approach is consistently employed for the management of patients with anorectal malformations (ARMs). The aim of our study is to evaluate the safety and feasibility of end-colostomies in specific subtypes of ARMs.Methods The medical records of babies born with an ARM treated between 01 January 2017 till 31 December 2022 were reviewed. Information regarding type of ARM, type of colostomy and complications at formation of colostomy, posterior sagittal anorectoplasty (PSARP), and colostomy closure was recorded.Results 194 patients were included: 137 patients had divided colostomies with distal mucus fistulas (DC) and 57 had end-colostomies (EC). Ninety-seven patients (50%) had perineal and vestibular fistulas: 40(42%) had DC and 57(58%) had EC. Post-colostomy formation, 8(20%) complications were recorded in the DC group 9(16%) and 8(20%) in the EC group(p-value:0.78). Wound sepsis presented in 6 patients with DC and 4 with EC(p-value:0.3). 16/85 patients (19%) that had a PSARP developed complications: 4/37(11%) with DC and 12/48(25%) with EC(p-value:0.16). Six(8%) complications occurred post 72 stoma reversal: 3 in DC and 3 in EC group.Conclusion In patients with rectoperineal and vestibular fistulas, where divided colostomies are not warranted, end colostomies provide a safe alternative.

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