Challenging Dogma: Does Colostomy Type Matter?

This is Todd Ponsky with the Journal of Pediatric Surgery and here's your two minute review. Today, we're going to be challenging dogma. You know, we've all been taught over the years that when we do a colostomy for an anorectal malformation, we should do a divided colostomy. And the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection. Is this true? Well, Dr. Robert Bard challenged this dogma. He did a meta-analysis of multiple studies to find out if a divided colostomy has a lower incidence of UTI than a loop colostomy. And in fact, he found no difference. There were some studies that did show a difference, but when he did the meta-analysis, overall, no statistical difference between loop colostomy or divided colostomy for the development of a urinary tract infection. However, what they did find was that the loop colostomies actually had a higher, significantly higher, stoma prolapse rate. So although there was no difference in UTI, there was a difference in stoma prolapse rate. They also looked at a series of other factors such as skin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture. And they found that none of these had any statistical difference between loop colostomy or divided colostomy. So there we go. We've challenged dogma and it seems like dogma necessarily at this point doesn't seem to hold true. We'll see you next time.