WOFAPS 2025 8th World Congress of Pediatric Surgery

Maria Moreno, Laura Rodriguez, Oscar Arguello, Fernando Fierro, Ivan Molina, Juan Seba, Juan Valero

Universidad Nacional de Colombia, Fundación Hospital pediátrico La Misericordia

Objective:

To evaluate complications associated with colostomies in pediatric patients diagnosed with anorectal malformations (ARMs) between January 2008 and December 2024.

Methods:

A retrospective case series was conducted including patients with ARM who underwent colostomy during the neonatal period. A univariate and bivariate analysis of procedure-related complications was performed. Ethics committee approval was obtained.

Results:

A total of 150 patients were included, 52% were female. The most common ARM in males was perineal fistula (16%), while in females it was rectovestibular fistula (22.6%). All patients with perineal fistula underwent colostomy as initial management due to delayed diagnosis presenting as chronic constipation. Colostomy performed at an outside institution in 77% of patients. The age at colostomy creation ranged from 1 day to 8 years. The most frequently performed technique was Peña-type colostomy (60%), with the most common site being the descending-sigmoid colon junction (74%). The median age at colostomy closure was 18.5 months (IQR: 24).

Thirty-nine percent of patients experienced complications related to the colostomy, the most frequent was stoma prolapse (12%), peristomal skin lesions and stoma inversion (9%). A total of 22.6% required surgical reintervention. Bivariate analysis revealed that loop colostomies were significantly associated with a higher complication rate (p < 0.05). When stratifying complications by level and type of colostomy, double-barrel colostomies without a skin bridge were more frequently associated with urinary tract infections and stomal stenosis.

Conclusions:

Peña-type colostomy was the most frequently used technique in our setting, even in patients with delayed diagnosis. It was associated with fewer complications compared to loop or double-barrel colostomies without a skin bridge. Standardization of surgical technique across institutions and multicenter prospective studies are recommended to reduce complication rates and optimize outcomes.