Five Years’ Single-center Experience of a Modified Approach to Divided Sigmoid Colostomy for Anorectal Malformation,Journal of Pediatric Surgery

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Five Years’ Single-center Experience of a Modified Approach to Divided Sigmoid Colostomy for Anorectal Malformation
Journal of Pediatric Surgery ( IF 2.4 ) Pub Date : 2023-08-09 , DOI: 10.1016/j.jpedsurg.2023.08.003
Muhammad Arslan Qureshi ₁ , Naeem Liaqat ₁ , Asif Iqbal ₁ , Ali Ashkanani ₁ , Sunil Kumar ₁ , Abdullah Rajab Ali ₁ , Suad Abdullah Hasan Abdul ₁ , Esmaeel Taqi ₁

Affiliation

Background

In patients with anorectal malformation (ARM), a divided descending colostomy is associated with high complication rates, including wound infection, dehiscence, and prolapse, and it places a significant burden on caregivers. To decrease the chances of such complications, we modified our approach for colostomy fashioning by keeping an intact skin bridge between the colostomy and mucous fistula. The objective was to compare the rate of complications among patients diagnosed with ARM who underwent a modified divided descending colostomy and classical descending colostomy.

Methods

We included all the patients diagnosed with ARM who underwent a divided colostomy with modified (group A) or classical technique (group B) in the last 5 years. The type of approach used to fashion the stoma was based on the surgeon's preference than on patients' selection criteria. All patients were followed and monitored for postoperative complications. SPSS version 26 was used to analyze the data.

Results

A total of 62 patients with ARM underwent the colostomy creation; 27 in group A and 35 in group B. Males were more in both groups and other demographic variables were comparable. The most common associated anomalies were cardiac (58%). The mean duration of surgery was 72.2 ± 18.26 min in group A while 91.25 ± 21.43 min in group B (P = 0.000). The mean hospital stay was 4.28 ± 3.63 days in group A while 7.97 ± 6.12 days in group B (P = 0.007). The overall complication rate was 14.8% in group A and 34.2% in group B (P = 0.082).

Conclusion

The modified approach to fashioning a divided colostomy is easily reproducible and carries a low risk of postoperative complications.

Level of Evidence

IV.

中文翻译：

改良乙状结肠造口术治疗肛门直肠畸形单中心五年经验

背景

在肛门直肠畸形（ARM）患者中，分开的降结肠造口术会导致高并发症发生率，包括伤口感染、裂开和脱垂，并且给护理人员带来了巨大的负担。为了减少出现此类并发症的机会，我们修改了结肠造口成型方法，在结肠造口和粘液瘘之间保持完整的皮肤桥。目的是比较诊断为 ARM 的患者接受改良分离式降结肠造口术和经典降结肠造口术的并发症发生率。

方法

我们纳入了在过去 5 年内接受改良技术（A 组）或经典技术（B 组）的分开结肠造口术的所有诊断为 ARM 的患者。用于塑造造口的方法类型取决于外科医生的偏好而不是患者的选择标准。对所有患者进行随访并监测术后并发症。SPSS 26 版用于分析数据。

结果

共有 62 名 ARM 患者接受了结肠造口术；A 组有 27 人，B 组有 35 人。两组中男性均较多，其他人口统计变量具有可比性。最常见的相关异常是心脏异常（58%）。A 组的平均手术时间为 72.2 ± 18.26 分钟，B 组为 91.25 ± 21.43 分钟（P = 0.000）。A 组的平均住院时间为 4.28 ± 3.63 天，B 组的平均住院时间为 7.97 ± 6.12 天（P = 0.007）。A组总体并发症发生率为14.8%，B组为34.2%（P=0.082）。