A comparison of loop and split stoma for the management of various congenital and acquired gastrointestinal disorders requiring colostomy: An analysis of complications and outcomes

TL;DR

This study compares loop and split colostomies in children, finding each has distinct complication risks that should guide clinical decisions.

Contribution

The study provides a detailed comparison of complication rates and outcomes between loop and split colostomies in pediatric gastrointestinal surgery.

Findings

Loop colostomies had higher rates of prolapse, evisceration, and overall complications compared to split colostomies.

Split colostomies showed higher rates of excoriation and wound dehiscence.

Stoma location influenced complication types, with small intestine stomas having more skin issues and sigmoid stomas more strictures.

Abstract

The study aimed to compare the outcomes and complications of loop colostomy (LC) and split colostomy (SC) in pediatric patients requiring colostomy for various congenital and acquired gastrointestinal disorders. Additionally, we also wanted to evaluate the advantages and disadvantages of each technique and determine their role in contemporary clinical practice.

This study includes patients at the Department of Pediatric Surgery, Dicle University Faculty of Medicine, between January 2010 to January 2025. A total of 589 patients were analyzed, with data collected on demographics, stoma type (loop or split), associated complications and clinical outcomes. Patients were categorized into two groups: Group-I (loop stoma) and Group-II (split stoma) and the findings were compared statistically.

The most common indications for stoma creation were anorectal malformations (43.8%), Hirschsprung’s disease (24.3%), gastrointestinal perforation (13.8%) and necrotizing enterocolitis (6.3%). Of the 589 patients, 59.3% had loop stomas and 40.7% had split stomas. Common complications included excoriation (11.2%) and wound dehiscence (10.5%). Loop stomas had higher rates of prolapse (16%), evisceration (2%) and overall complications (38%), while split stomas showed higher rates of excoriation (14%) and wound dehiscence (14%). Stomas in the small intestine had higher rates of skin-related complications, while those in the sigmoid colon had a higher rate of stricture (3%).

Both loop and split stomas are effective for managing pediatric gastrointestinal disorders, but each technique carries its own risk profile. Loop colostomies are more prone to prolapse and other internal complications, while split colostomies tend to have more skin-related issues. The choice of stoma type should be tailored to each patient’s specific clinical condition and anatomy.