Colostomy procedure is very commonly needed in the neonatal period. Congenital abnormalities were the most frequent reasons for the need of a colostomy in this age group. Although ARM and HD have been treated without colostomy in the recent years, and we also perform this approach in our clinic, the number of patients needing colostomy is quite high
6,7. The literature indicates that colostomies are most frequently performed in the neonatal period and in the cases with ARM
4,8.
The rate of colostomy complications were reported between 30-74% in the literatüre3,5,8-10. This rate was 36% in our study. The complications most frequently occurred in patients with ARM and HD. This may be related to similar diagnoses in patients who had colostomies. Cigdem et al have shown that the site of colostomy is not correlated with the development of complications4. In our study, the site of colostomy was not considered as statistically significant to be correlated with the complications, in accordance with the literature (p>0.05).
The most frequently encountered complication reported in the literature is peristomal dermatitis which was seen in 30.5% of all complications5. In our study, peristomal dermatitis comprised 53% of all complications. We suppose that peristomal dermatitis develops due to inadequate colostomy care and irritation of the insufficiently absorbed bile salts. Peristomal dermatitis does not have an effect on mortality, but it has a negative effect on the quality of life.
The primary disease is important for determining the site and the type of the colostomy. In our study, sigmoid separated colostomy was observed as the most frequent site and type of colostomy. However, loop colostomy was reported as the most frequent colostomy type in the past wheras the sigmoid and transverse colons revealed as the most frequent colostomy sites1,8.
Mucosal bleeding was reported in 0-10.3% of the patients in the literatüre5,8. It was the second most frequent complication detected in our study with a rate of 11%. All patients who had mucosal bleeding were under the 1 year of age. This may be related to non-use of the colostomy bags in this age group.
Prolapse is a complication that occurs after colostomy, and sometimes needs a revision. It's rate was 11% in our study. This complication can usually be treated conservatively, but sometimes surgery could be required. Prolapse rate was reported as high as 23.3% in the literatüre5, however this rate was relatively low in or study. Three of these 4 cases needed a revision. In cases with the prolapse of distal stoma opening, a purse string suture was used at the level of the fascia8-11.
The literature indicates stomal stenosis rates between 0.7 and 6.3%8-10. In our study, the rate of stomal stenosis was found as 5.5%, in accordance with the literature. We have the opinion that stomal stenosis or obstruction could be related to the surgical technique. All stenosis cases were operated in the education period of the surgeons.
The revision rate reported in the literature is as high as 16.7%8. Our revision rate was 7%. Revisions were due to prolapse in 3, obstruction in 2, and ischemia in 2 patients. Four patients who had revisions had ARM, were younger than 1 year of age, had transverse colostomies and were males. These variables represent the most frequently seen pathology, age and gender in our patient group, and we consider that these findings occur due to the frequency of these variables. Our revision rate was found to be in accordance with the literature.
The mortality rate has been reported between 2,7- 9.5 % in the literatüre4,5,8,9,12. In this study, death occurred in 10% of the patients. Colostomy was not the primary reason of death in any of these patients. All patients were in the neonatal period and 8 of them were patients who underwent colostomy procedure due to ARM. Mortalities were related to additional congenital abnormalities, notably to cardiovascular ones.
Congenital abnormalities are the most common disorders necessitating colostomies in children, and additional abnormalities are the most important factors determining mortality. The primary pathology is the most important factor in the development of the colostomy complications. Dermatitis, one of the most frequently seen complications, was found in girls with ARM who were older than one month of age and had transverse separated colostomy. Although colostomies' have high complication rate, the number of patient who need revision is low.