The need for diverting colostomy in obstetric and non-obstetric anorectal injury repair

Abstract

Between 0,2% and 6% of women experience severe anorectal injuries in the form of third- and fourth-degree tears during vaginal birth. Early diagnosis and correct repair by experienced surgeons reduce morbidity and devastating complications such as faecal incontinence and fistulae formation. While there is sufficient evidence for the correct surgical suturing techniques, the use of diverting colostomies remains controversial and poorly researched. In this review we performed a MEDLINE search of all published studies on the role of diverting colostomies in obstetric and non-obstetric anorectal injury repair. Most authors avoid commenting on the utility of colostomies as part of their surgical approach making it difficult to make recommendations for clinical practice. We conclude that, based on published opinions, case series and clinical outcomes, the use of colostomy is seldom warranted. Comparative data is absent and further research is needed.