Comparing Loop and Divided Colostomy for Anorectal Malformation: A Systematic Review and Meta-Analysis
Infographic · Dec 2024 · 1 min read
In brief
In brief
Systematic review of 2,550 neonates with anorectal malformations found no significant difference in complication rates between loop and divided colostomies. Both techniques are viable for fecal diversion, with choice dependent on patient factors and surgeon experience.
- Loop and divided colostomies show no significant difference in complication rates for anorectal malformation patients (n=2550).
- Stoma prolapse, UTI, skin excoriation, retraction, hernia, infection, and stricture rates are comparable between techniques.
- Choice of colostomy type should be individualized based on patient factors and surgeon experience, not complication profile.
- Meta-analysis of 11 studies provides Level 1 evidence that both techniques are equally safe for fecal diversion in ARM.
Written by the GCMD Library team from the infographic.
Gonca Gerçel, Mustafa Azizoglu, Esra Karakas, Toni Risteski, Maria Escolino, Luis De La Torre
Introduction: The optimal type of colostomy for patients with anorectal malformations (ARM) remains unclear. We conducted a systematic review and meta-analysis to compare the clinical outcomes of loop colostomies (LC) versus divided colostomies (DC) in patients with ARM.
Methods: After review registration (PROSPERO: CRD42024513335), we searched multiple databases for comparative studies on LCs and DCs in patients with ARMs. Gray literature was sought. The complications examined included stoma prolapse, urinary tract infection (UTI), skin excoriation, stoma retraction, parastomal hernia, wound infection rate, and stoma stricture. Three reviewers independently assessed the eligibility and quality of the included studies. Meta-analysis of selected complications was performed using Revman 5.4, with p < 0.05 considered significant.
Results: Eleven studies were included in the analysis, incorporating a total of 2550 neonates with ARMs, of which 1147 underwent LCs and 1403 underwent DCs. The meta-analysis revealed no significant differences between the two groups in the incidence of stoma prolapse (OR: 1.55, 95 % CI: 0.63 to 3.79; p = 0.34), UTIs (OR: 1.78, 95 % CI: 0.50 to 6.36; p = 0.38), skin excoriation (OR: 1.26, 95 % CI: 0.68 to 2.34; p = 0.46), stoma retraction (OR: 0.79, 95 % CI: 0.09 to 6.64; p = 0.83), parastomal hernia (OR: 0.99, 95 % CI: 0.22 to 4.48; p = 0.99), wound infection (OR: 0.35, 95 % CI: 0.10 to 1.20; p = 0.10), and stoma stricture (OR: 0.70, 95 % CI: 0.22 to 2.18; p = 0.53).
Conclusions: The findings suggest that LCs and DCs are viable options for fecal diversion, presenting similar risks and benefits. The choice between these techniques should consider individual patient characteristics and surgical expertise.