Are end colostomies always contraindicated in anorectal malformations?

Abstract

Background. In our clinical setting, a three-staged approach is consistently employed to manage patients with anorectal malformations (ARMs). Objective. To evaluate the safety and feasibility of end-colostomies, in particular subtypes of ARMs. Methods. The medical records of babies born with an ARM treated between 1 January 2017 and 31 December 2022 were reviewed. Information regarding the type of ARM, type of colostomy, complications during colostomy formation, posterior sagittal anorectoplasty (PSARP) and colostomy closure was recorded. Results. Ultimately, 194 patients were included. Of those, 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, including 40 (41%) patients with DC and 57 (59%) with EC. For post-colostomy formation, eight (20%) complications were recorded in the DC group and nine (16%) in the EC group (p=0.78). Wound sepsis presented in six patients with DC and four with EC (p=0.3). Nineteen percent (16/85) of patients who had PSARP developed complications, including 4/37 (11%) with DC and 12/48 (25%) with EC (p=0.16). Of the 72 patients who underwent stoma reversal, six (8%) had complications post-operatively: three in the DC group and three in the EC group. Conclusion. For patients with rectoperineal and vestibular fistulas, where divided colostomies are not warranted, end colostomies provide a safe alternative.