Outcome of Divided and Loop Sigmoid Colostomy for the Management of Anorectal Malformation (ARM): A Comparative Study

Background: Anorectal Malformation (ARM) is one of the common congenital anomalies in the world. There are various surgical options for management of ARM. Colostomy is usually performed as a first stage in a new born with high and intermediate variety of anorectal malformations. The aim of the study was to compare the clinical outcomes between divided and loop sigmoid colostomy for the management of anorectal malformations. Material and Methods: This prospective comparative study was conducted on 130 pediatric patients at the Faculty of Pediatric Surgery, Bangladesh Shishu Hospital and Institute, who were admitted with anorectal malformations (ARM) up to 7 days of age, from March 2018 to February 2021. Informed consent was obtained after proper counselling with the guardian. They were randomly assigned to the divided sigmoid colostomy group (group 1=65 neonates) and loop sigmoid colostomy group (group 2=65 neonates). The comparative parameters between two groups were the operation time, post-operative complications such as wound infection, skin excoriation, prolapse of colostomy, retraction of colostomy and parastomal hernia. All patients were followed up for 2 months post-operatively. Results: The mean age of the patients was 2.43±1.39days in group 1 and in group 2, the mean age was 2.61±1.73 days where majority of the patients were male. The statistical difference between the two groups regarding operation time was highly significant (0.0001). After operation, 26.15% patients developed skin excoriation in group 1 where in group 2, 29.23% patients developed skin excoriation. In group 1, 6.15% patients developed wound infection but none of them developed prolapse, retraction of colostomy and parastomal hernia. On the other hand, in group 2, 1.54% patient developed wound infection, 15.38% patients developed prolapse and 6.15% patients developed retraction of colostomy and no patient experienced parastomal hernia. The statistical difference between the two groups regarding prolapse of colostomy was significant (p=0.042). Conclusion: In our study, the frequency of different stoma-related problems was greater in the loop colostomy group, although being statistically insignificant. In the divided group, there was significantly less stoma prolapse. In light of these results, divided stoma should be suggested for newborns with ARM.