Are end colostomies always contraindicated in anorectal malformations?

Abstract

Abstract 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.