Complications of Stoma in Patients with Anorectal Malformation
The procedure of creating stoma
Background: The procedure of creating stoma is the initial surgical step in the treatment of patients with congenital anorectal malformation. It has the advantages of decompressing the distended colon, preventing fecal contamination of the urinary tract and protecting the final perineal repair but it carry a lot of complications, some of them are simple while the other are serious.
Objectives: To highlights the prevalence and type of complications in addition to their relation to the type and site of commonly performed stoma and the best strategy to avoid them.
Methods: In this prospective study (from Oct 2011 to Aug 2015), we followed up all the patients with congenital anorectal malformation who visit our center of pediatric surgery at the central child teaching hospital. The type of anorectal malformation, whether a diverting stoma is indicated or not, type of stoma performed, which part of the bowel is used, age of the patient during creation and during closure of stoma in addition to the rate and type of complication related to stoma and stoma closure were evaluated.
Results: We evaluated 75 patients with stoma out of total 87 patients with anorectal malformation during 4 years of study. Male: female ratio was 1.4:1. The most common types of malformation in male was imperforate anus with rectourethral fistula (33 cases) while in female it was imperforate anus with rectovestibular fistula (23 cases). The other rare types were rectovesical fistula, imperforate anus without fistula, rectoperineal fistula, rectal atresia, congenital pouch colon syndrome, cloaca and complex syndromic anorectal malformation. The prevalent type of stoma was separated (42) followed by loop (29), end stoma (2), and window stoma (2). The most common location of stoma was in the descending colon (41), then sigmoid colon (24), transvers colon (5), ileum (3) and pouch colon (2). Total complication rate was 45% (34/75). The complication rate was higher in loop stoma than in separated stoma, the main complication of loop stoma was prolapse, megarectum formation and urinary tract infection, while the wound problems like infection, dehiscence, evisceration, reversed direction and stenosis were the remarkable problems of separated stomas. More than 60% of complications occur at age older than 4 months. There was no significant difference in mortality rate between loop and separated stomas, regardless the location of stoma.
Conclusion: The ideal stoma in patients with anorectal malformation is separated descending colostomy due to its low incidence of complications and valuable advantages compared with other types of stomas. Although minor procedure, formation of stoma should be performed by experienced hands. Earlier closure of stoma after completing surgical repair significantly decreases complication rate.
Keywords: Anorectal malformation, Stoma, Complication.Iraqi Medical Journal Vol. 63, No. 1, January 2017; p.29-38.
Copyright (c) 2017 Iraqi Medical Journal
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