WOFAPS 2025 8th World Congress of Pediatric Surgery

Nabila Talat, Aziz Ahmed Chattha, Muhammad Zubair Shoukat, Jamaal Butt, Mudassar Naveed

University of child health sciences, The Childrens Hospital, Lahore

Background

Mechanical bowel preparation (MBP) has traditionally been employed prior to colostomy closure to reduce the risk of postoperative infection and anastomotic complications. However, emerging evidence in adult and pediatric surgery suggests that MBP may be unnecessary and potentially detrimental.

Objective
To compare clinical outcomes of colostomy reversal in pediatric patients with and without mechanical bowel preparation (MBP), using interim data from an ongoing randomized controlled trial.

Method
This ongoing randomized controlled trial enrolled pediatric patients undergoing colostomy reversal. Participants were randomly allocated using the lottery method into two groups: MBP group (n=13) and no-MBP group (n=28). Outcomes analyzed included anastomotic leakage, wound infection, time to first and full enteral feeding, and length of hospital stay. Data were analyzed using SPSS version 26. Categorical variables were assessed via chi-square or Fisher’s exact test, while continuous variables were compared using independent samples t-tests. A p-value <0.05 was considered statistically significant.

Results
Among the 41 patients included in this interim analysis, anorectal malformations were the most common indication for colostomy (80.5%). No anastomotic leaks were reported in either group. Wound infections occurred in one patient per group (4.9%). Mean time to first feed was 43.51± 24.35 hours, and the mean time to full feed was 75.22 ± 21.63 hours. Use of ERAS protocol (n= 13) was associated with early resumption of feeding across both groups. Hospital stay was significantly longer in the MBP group (8.2 ± 1.1 vs. 5.3 ± 1.0 days, p<0.001).

Conclusion

We observed a significant reduction in hospital stay with omitting MBP while no difference in post operative anastomotic or wound complications was observed. So, it is safe to conclude on available data that colostomy reversal without MBP is safe and helps reduce morbidity by shortening hospital stay.