Classic divided sigmoidostomy vs loop sigmoidostomy in anorectal malformations: time for change?
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In brief
In brief
Comparative study challenges the traditional preference for divided sigmoidostomy in anorectal malformation patients. Laparoscopic loop sigmoidostomy showed fewer complications, faster recovery, and shorter hospital stays without increased risk of prolapse or urinary tract infections compared to open divided sigmoidostomy.
- Loop sigmoidostomy shows no increased risk of prolapse or UTI compared to divided sigmoidostomy in ARM patients.
- Divided sigmoidostomy had significantly higher postoperative complications (48% vs 9%), primarily wound-related issues.
- Loop sigmoidostomy patients achieved faster oral intake and stoma function with shorter hospital stays (8 vs 36 days median).
- Laparoscopic loop sigmoidostomy may be preferable to open divided sigmoidostomy for ARM based on complication profiles.
- Traditional concerns about loop sigmoidostomy complications in ARM are not supported by this comparative study.
Written by the GCMD Library team from the article.
Abstract
Purpose
Divided sigmoidostomy (DS) is the classic stoma for patients with anorectal malformations (ARM). Loop sigmoidostomies (LS) in ARM are associated with a higher risk of stoma prolapse and urinary tract infections (UTI). This is not clearly supported by literature. We compared our experience with both techniques.
Methods
Retrospective study of ARM patients who underwent DS or LS between 2013 and 2023. We analysed demographics, associated malformations, intraoperative variables, oral intake and stoma functioning times, hospital stay, complications, prolapses, and UTI.
Results
Of 40 patients, 29 underwent open DS and 11 laparoscopic LS. Demographics, malformation type, associated anomalies, surgical time, intraoperative and anaesthetic complications were comparable. Postoperative complications were higher in DS than LS [14(48.3%) vs 1(9.1%), (p = 0.02)], mostly due to wound complications [12(41.3%) vs 0(0%), (p = 0.01)]; with 3 dehiscenses and 3 strictures reintervened. The hours to oral intake and stoma functioning were higher for DS [48(39–90) and 48(24–48) vs 24(24–48) and 24(24–24), (p < 0.05)], with more days of hospital stay [36(19–60) vs 8(5–10), (p = 0.001)]. Prolapses [1(3.4%) vs 1(9.1%)] and UTIs [3(10.3%) vs 1(9.1%) (p > 0.05)] were comparable.
Conclusion
LS in ARM patients have no higher risk of prolapse or UTI than DS. DS had more complications, mostly wound infections, strictures and dehiscenses.