Complications of Colostomy Reversal in Patients with Imperforate ANUS

Abstract

Background: Colostomy reversal after definitive procedure in patients of Imperforate  Anus (for example; PSARP) can be difficult and challenging for  surgeon due to proximal and distal gut lumen discrepancy, short length of distal loop, difficult mobilization of stoma. These factors affect the anastomosis and anastomosis is done under tension due to these factors. Colostomies which are reversed under tension mostly results in anastomosis leakage and increases the morbidity and mortality rate. The objective of this study to assess postoperative outcome in terms of complications following colostomy closure in patients with imperforate anus.

Material and Methods: This is a prospective study done at  the Department of Pediatric  Surgery, National Institute of Child Health Karachi during the period of  6months   from   December   2016  to   June  2017. A  Self- structured performa was   used   to  collect  the data  of  total  84  Patients  who  Underwent  Colostomy  Reversal   after definitive  procedure  for  imperforate anus . Data analyzed through SPSS version 20. A  descriptive  statistical  analysis  of  continous  and categorical variables  were  performed.  Continuous   data   (like age)   expressed  as mean SD^.  The   categorical data   like   gender,  wound infections , anastomosis  leakage  expressed   in  frequency  and   percentages.

Results:  Out   of   total   84   children, majority  51 (60.7%) children    were    presented with   ≤4 years  of  age  (Mean age 4.15±3.12 years). Majority 55 (65.5%)   children   were  presented   with  >8 kg  of weight  (Mean weight 13.31±6.00 kg). There   were   41 (48.8%) males   and  43 (51.2%)  females.  Intra-operative  difficulty  was  found in 55 (65.5%) children. Postoperative complication showed that wound infections were observed in 10 (11.9%) children while  frequency of anastomotic leakage  was  found   in  12 (14.3%) children.

Conclusion: Anastomotic leakage was found to be higher following colostomy closure in children with intra-operative difficulty due to proximal and distal gut lumen discrepancy, short length of distal loop  and dense adhesions making  difficult the  mobilization of stoma.