To Split or Not to Split: Colostomy Complications for Anorectal Malformations or Hirschsprung Disease: A Single Center Experience and a Systematic Review of the Literature

Abstract

Introduction The aim of this article is to identify the ideal type and location of colostomy in children with colorectal disease.

Patients and Methods A retrospective case study of children with an anorectal malformation who received a colostomy, born between January 1990 and July 2012. Furthermore, a systematic literature search on colostomies in neonates with an anorectal malformation or Hirschsprung disease. Colostomies were classified as loop or split colostomies in the transverse or sigmoid colon. Outcome measures were mortality and complications such as prolapse, technical difficulties with the reconstruction, urinary tract infections, and others.

Results The mortality rate in the 180 children with anorectal malformation was 6%, and none of them were directly related to stoma formation or closure. The overall complication rate was 23% and the specific rates for the two types of procedures and the two locations of the colostomy did not differ (p = 0.389 and p = 0.667, respectively). All prolapses (n = 22) occurred in loop colostomies in the transverse colon. One colostomy required revision because of insufficient length for the reconstruction. Urinary tract infections were not documented. A total of eight studies were included in the systematic review (1982–2011; 2,954 patients). Mortality ranged between 0.1 and 11%. Loop colostomies had more complications than split colostomies (63 vs. 45%; p = 0.007), mainly prolapse (18 vs. 6%; p < 0.001). Overall complication rate differed between transverse en sigmoid colostomies (62 vs. 51%, p = 0.006), and prolapse occurred more often in the transverse colon (23 vs. 7%; p < 0.001). Revision because of insufficient length during the reconstruction was needed in 0 to 6%. Two studies reported on urinary tract infections which are as follows: One showed no difference between loop or split colostomies, whereas the other showed frequent episodes of urinary tract infections in 64% of the loop colostomies.

Conclusions The complication to be avoided in transverse colostomies is prolapse and the surgical technique should be modified accordingly. The procedure of split sigmoid colostomy is meticulous, and the risk of insufficient length for the reconstruction remains.

Keyword

anorectal malformation - Hirschsprung disease - colostomy - complications - mortality

• References

• 1 Puri P, Peña A, Levitt MA. Hirschsprung's disease, anorectal malformations. In: Puri P, Höllwarth ME, , eds. Pediatric Surgery. Heidelberg, Germany: Springer-Verlag Berlin Heidelberg New York; 2006: 275-312
• 2 Moore AR. The birth of colostomy. Aust N Z J Surg 1976; 46 (3) 281-285
• 3 Peña A, Migotto-Krieger M, Levitt MA. Colostomy in anorectal malformations: a procedure with serious but preventable complications. J Pediatr Surg 2006; 41 (4) 748-756 , discussion 748–756
• 4 Holschneider A, Hutson J, Peña A , et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J Pediatr Surg 2005; 40 (10) 1521-1526
• 5 Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998; 52 (6) 377-384
• 6 Ciğdem MK, Onen A, Duran H, Oztürk H, Otçu S. The mechanical complications of colostomy in infants and children: analysis of 473 cases of a single center. Pediatr Surg Int 2006; 22 (8) 671-676
• 7 Demirogullari B, Yilmaz Y, Yildiz GE , et al. Ostomy complicatıons in patients with anorectal malformations. Pediatr Surg Int 2011; 27 (10) 1075-1078
• 8 Ng WT, Book KS, Wong MK, Cheng PW, Cheung CH. Prevention of colostomy prolapse by peritoneal tethering. J Am Coll Surg 1997; 184 (3) 313-315
• 9 Nour S, Beck J, Stringer MD. Colostomy complications in infants and children. Ann R Coll Surg Engl 1996; 78 (6) 526-530
• 10 Patwardhan N, Kiely EM, Drake DP, Spitz L, Pierro A. Colostomy for anorectal anomalies: high incidence of complications. J Pediatr Surg 2001; 36 (5) 795-798
• 11 Rees BI, Thomas DFM, Negam M. Colostomies in infancy and childhood. Z Kinderchir 1982; 36 (3) 100-102
• 12 Wilkins S, Peña A. The role of colostomy in the management of anorectal malformations. Pediatr Surg Int 1988; 3: 105-109
• 13 Golladay ES, Bernay F, Wagner CW. Prevention of prolapse in pediatric enterostomas with purse string technique. J Pediatr Surg 1990; 25 (9) 990-991
• 14 Hamada Y, Takada K, Nakamura Y, Sato M, Kwon AH. Temporary umbilical loop colostomy for anorectal malformations. Pediatr Surg Int 2012; 28 (11) 1133-1136
• 15 Chirdan LB, Uba FA, Ameh EA, Mshelbwala PM. Colostomy for high anorectal malformation: an evaluation of morbidity and mortality in a developing country. Pediatr Surg Int 2008; 24 (4) 407-410