Neonatal single-site divided colostomy in anorectal malformation

PURPOSE: To evaluate outcomes of a single-site divided colostomy in neonates with anorectal malformations (ARM). METHODS: A retrospective review was conducted of neonates with ARM undergoing colostomy creation between 2012 and 2024 at a tertiary referral center. The technique used a divided colostomy with the proximal limb raised ~ 1.5 cm above skin level and a narrowed distal mucous fistula within the same opening, allowing coverage with a single stoma bag. The distal bowel was irrigated at surgery. Complications were classified using the Clavien-Madadi (CM) system. RESULTS: Sixty-one patients (79% male) were included, operated at a median age of 1 (1-3) day. Postoperative complications occurred in 12 (20%) patients. Two (3%) had CM IIIb complications (parastomal hernia and misidentification of bowel limbs). Urinary tract infection (CM II) developed in 6 (10%) patients; three with rectourethral fistula (one with vesicoureteral reflux), two with cloaca, and one without a fistula. Additional complications included granulation tissue requiring treatment (1) and wound infections requiring antibiotics (3). Major dressing difficulties were reported in 5 (8%) patients, while 20 (33%) had minor to moderate issues managed conservatively. CONCLUSION: Single-site divided colostomy is a safe technique with predominantly minor complications, minimal scarring, and no observed fecal overflow.