Outcomes of surgical treatment of neonates with intestinal stomas in a regional perinatal center


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. Emergency intestinal surgeries in neonates can lead to stoma formation. Indications for stoming, associated complications and ways to prevent them are being actively discussed. The aim of this study was to analyze results of surgical treatment of neonates with intestinal stomas in a perinatal center for the last 10 years.

Material and methods. 81 children with intestinal obstruction (32), necrotizing enterocolitis (27), meconium ileus (14) and others abdominal pathologies (8) were included into the study. Statistical processing was carried out using the SPSS v.26 package; differences were significant at p-value ≤0.05. Complications were assessed with the Clavien-Dindo Сlassification (CDC).

Results. There were 59 premature infants (72.8%); 32 had body weight below 1000 grams (54.2%). Initially performed: 15 (18.5%) colostomies, 49 (60.5%) enterostomies, 17 (21%) T-anastomoses. A compression clip was put in six children with double-barreled ileostomies. Complications were the following: prolapse (12.3%), skin excoriation (43.2%), bleeding (19.8%), large losses of intestinal chyme (17.3%), liver failure (19.8%), sepsis (17.3%), wound dehiscence (6.2%), adhesive obstruction (16%), necrosis (9.9%) and stenosis (7.4%). 16 (19.7%) patients had no complications. 28 (43%) patients had complications by CDC of grade

Conclusion. If a neonate patient has contraindications to primary anastomosing, double-barreled enterostomy with a compression clip is a safe alternative to it. The enterostomy technique in premature newborns does not increase the rate of complications and mortality. Skin excoriation, increased bleeding from the stoma, and liver failure are most common in neonates with enterostomy.

About the authors

S. D. Ivanov

Siberian State Medical University; Evtushenko Regional Perinatal Center

Author for correspondence.
Email: ivanov_st@mail.ru
ORCID iD: 0000-0001-8439-901X

Stanislav D. Ivanov, MD, post-graduate student in department of pediatric surgery at the Siberian State Medical University; pediatric surgeon at the Evtushenko Regional Perinatal Center

Tomsk, 634050

Russian Federation

G. V. Slizovskij

Siberian State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0001-8217-5805

Tomsk, 634050

Russian Federation

D. A. Balaganskiy

Evtushenko Regional Perinatal Center

Email: fake@neicon.ru

Tomsk, 634063

Russian Federation

V. G. Pogorelko

Evtushenko Regional Perinatal Center

Email: fake@neicon.ru

Tomsk, 634063

Russian Federation

A. B. Yushmanova

Evtushenko Regional Perinatal Center

Email: fake@neicon.ru

Tomsk, 634063

Russian Federation

References

  1. Козлов Ю.А., Подкаменев В.В., Новожилов В.А. Непроходимость желудочно-кишечного тракта у детей: национальное руководство. М.: ГЭОТАР-Медиа; 2017.
  2. Козлов Ю.А., Новожилов В.А., Разумовский А.Ю. Хирургические болезни недоношенных детей: национальное руководство. М.: ГЭОТАР–Медиа; 2019. doi: 10.33029/9704-5072-7-2019-HBN-1-592
  3. Hillyer M.M., Baxter K.J., Clifton M.S., Gillespie S.E., Bryan L.N., Travers C.D. et al. Primary versus secondary anastomosis in intestinal atresia. Journal of pediatric surgery. 2019; 54(3): 417–22. doi: 10.1016/j.jpedsurg.2018.05.003
  4. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2): 205–13. doi: 10.1097/01.sla.0000133083.54934.ae
  5. Павлушин П.М., Грамзин А.В., Койнов Ю.Ю., Кривошеенко Н.В., Цыганок В.Н., Чикинёв Ю.В. Опыт хирургической коррекции атрезии различных отделов тонкой кишки. Медицинский альманах. 2019; 5(61): 26–9. doi: 10.21145/2499-9954-2019-5-26-29
  6. Haricharan R. N., Gallimore J. P., Nasr A. Primary anastomosis or ostomy in necrotizing enterocolitis? Pediatric surgery international. 2017; 33(11): 1139–45. doi: 10.1007/s00383-017-4126-z
  7. Peng Y. F., Zheng H. Q., Zhang H., He Q. M., Wang Z., Zhong W., et al. Comparison of outcomes following three surgical techniques for patients with severe jejunoileal atresia. Gastroenterology report. 2019; 7(6): 444–8. doi: 10.1093/gastro/goz026
  8. Martynov I., Raedecke J., Klima-Frysch J., Kluwe W., Schoenberger J. The outcome of Bishop-Koop procedure compared to divided stoma in neonates with meconium ileus, congenital intestinal atresia and necrotizing enterocolitis. Medicine. 2019; 98(27):e16304. doi: 10.1097/MD.0000000000016304.
  9. Баиров Г.А., Манкина Н.С. Хирургия недоношенных детей. Ленинград: Медицина, 1987.
  10. Дорошевский Ю.Л., Немилова Т.К. «Т-образный» анастомоз в лечении острой кишечной непроходимости у новорожденных. Вестник хирургии. 1979; 12: 3–19.
  11. Wit J., Sellin S., Degenhard P., Scholz M., Mau H. Is the Bishop-Koop anastomosis in treatment of neonatal ileus still current. Chirurg. 2000; 71: 307–10.
  12. Struijs M.C., Sloots C.E., Hop W.C., Tibboel D., Wijnen, R.M. The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review. Pediatric surgery international. 2012; 28(7): 667–72. doi: 10.1007/s00383-012-3091-9.
  13. Banerjee D.B., Vithana H., Sharma S., Tsang T. Outcome of stoma closure in babies with necrotising enterocolitis: early vs late closure. Pediatric surgery international. 2017; 33(7): 783–6. doi: 10.1007/s00383-017-4084-5.
  14. Al-Hudhaif J., Phillips S., Gholum S., Puligandla P. P., Flageole H. The timing of enterostomy reversal after necrotizing enterocolitis. Journal of pediatric surgery. 2009; 44(5): 924–7. doi: 10.1016/j.jpedsurg.2009.01.028.
  15. Lee J., Kang M.J., Kim H.S., Shin S.H., Kim H.Y., Kim E.K. et al. Enterostomy closure timing for minimizing postoperative complications in premature infants. Pediatrics and neonatology. 2014; 55(5): 363–8. doi: 10.1016/j.pedneo.2014.01.001.
  16. Yang H.B., Han J.W., Youn J.K., Oh C., Kim H.Y., Jung, S.E. The optimal timing of enterostomy closure in extremely low birth weight patients for acute abdomen. Scientific reports. 2018; 8(1): 15681. doi: 10.1038/s41598-018-33351-9.
  17. Talbot L.J., Sinyard R.D., Rialon K.L., Englum B.R., Tracy E.T., Rice H.E. et al. Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation. Journal of pediatric surgery. 2017; 52(1): 35–9. doi: 10.1016/j.jpedsurg.2016.10.015
  18. Wolf L., Gfroerer S., Fiegel H., Rolle U. Complications of newborn enterostomies. World journal of clinical cases. 2018; 6(16): 1101–10. doi: 10.12998/wjcc.v6.i16.1101.
  19. Haithem H. Ali Almoamin. Meconium ileus: study and comparison between common operative procedures performed in Basrah. Basrah Journal of Surgery. 2016; 22(2): 84–90. doi: 10.33762/bsurg.2016.116618.
  20. Ohashi K., Koshinaga T., Uehara S., Furuya T., Kaneda H., Kawashima H., et al. Sutureless enterostomy for extremely low birth weight infants. Journal of pediatric surgery. 2017; 52(11): 1873–7. doi: 10.1016/j.jpedsurg.2017.08.009.
  21. Sparks E.A., Velazco C.S., Fullerton B.S., Fisher J.G., Khan F.A., Hall A.M., et al. Ileostomy Prolapse in Children with Intestinal Dysmotility. Gastroenterology research and practice. 2017; ID 7182429. doi: 10.1155/2017/7182429.
  22. Wong K.K., Lan L.C., Lin S.C., Chan A.W., Tam P.K. Mucous fistula refeeding in premature neonates with enterostomies. Journal of pediatric gastroenterology and nutrition. 2004; 39(1): 43–5. doi: 10.1097/00005176-200407000-00009.
  23. Haddock C.A., Stanger J.D., Albersheim S.G., Casey L.M., Butterworth, S. A. Mucous fistula refeeding in neonates with enterostomies. Journal of pediatric surgery. 2015; 50(5): 779–82. doi: 10.1016/j.jpedsurg.2015.02.041.
  24. Bhat S., Cameron N. R., Sharma P., Bissett I. P., O’Grady G. Chyme recycling in the management of small bowel double enterostomy in pediatric and neonatal populations: A systematic review. Clinical nutrition ESPEN. 2020; 37: 1–8. 10.1016/j.clnesp.2020.03.013.
  25. Гассан Т.А., Степанов Э.А., Красовская Т.В., Голоденко Н.В. Морфологическое обоснование тактики при закрытии кишечных стом, сформированных в периоде новорождённости. Детская хирургия. 2003; 6: 10–5.
  26. Макаренко Т.П., Богданов А.В. Свищи желудочно-кишечного тракта. М.: Медицина; 1986.
  27. Bell R.H., Johnson F.E., Lilly J.R. Intestinal anastomoses in neonatal surgery. Annals of surgery. 1976; 183(3): 276–81. doi: 10.1097/00000658-197603000-00011.
  28. Koivusalo A., Pakarinen M., Lindahl H., Rintala R.J. Preoperative distal loop contrast radiograph before closure of an enterostomy in paediatric surgical patients. How much does it affect the procedure or predict early postoperative complications?. Pediatric surgery international. 2007; 23(8): 747–53. doi: 10.1007/s00383-007-1968-9.
  29. Grant C.N., Golden J.M., Anselmo D.M. Routine contrast enema is not required for all infants prior to ostomy reversal: A 10-year single-center experience. Journal of pediatric surgery. 2016; 51(7): 1138–41. doi: 10.1016/j.jpedsurg.2015.12.011.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies