Abstract
PurposeIntestinal perforation and necrotizing enterocolitis (NEC) are neonatal intestinal emergencies that are especially common in premature infants. While prompt surgical intervention, including stoma creation, is often required, the optimal surgical treatment has been controversial because of the substantial risks related to the stoma creation and management. The use of a tissue adhesive may have some advantages over the use of sutures when creating an intestinal stoma in extremely low birth weight (ELBW) infants. The purpose of this report was to present a novel approach for creating a stoma using a tissue adhesive in ELBW infants.MethodsA total of eight ELBW infants that underwent laparotomy with the creation of intestinal stomas using cyanoacrylate adhesive at our institution between 2009 and 2014 were enrolled. The clinical parameters, including the length of the operation, intra- and postoperative complications and the outcomes were evaluated.ResultsThe median body weight and gestational age at birth were 630 g and 24.3 weeks, respectively. The median age at referral was 11.5 days. The median length of the procedure was 58.5 min, including the inspection and resection of the intestine. All procedures were completed without any intraoperative complications. There were no postoperative complications associated with the stoma. Two patients died of the associated septic status.ConclusionsSutureless enterostomy using cyanoacrylate adhesive is a simple technique which has the potential to reduce the incidence of complications related to the intestinal stoma in ELBW infants.
Highlights
Despite recent advances in neonatal care, idiopathic intestinal perforation and necrotizing enterocolitis (NEC) occur increasingly in extremely low birth weight (ELBW) infants with high mortality and morbidity rate
Sutureless enterostomy using cyanoacrylate adhesive is a simple technique which has the potential to reduce the incidence of complications related to the intestinal stoma in ELBW infants
These data show that the step to improve overall survival among ELBW infants is to overcome intestinal perforation requiring surgical management
Summary
Despite recent advances in neonatal care, idiopathic intestinal perforation and necrotizing enterocolitis (NEC) occur increasingly in extremely low birth weight (ELBW) infants with high mortality and morbidity rate. The Japanese Society of Pediatric Surgeons stated that the mortality rate of intestinal perforation ranged from 16.9 % in 2003–2007, to 18.2 % in 2008–2013, and of NEC was still over 20 %. These data show that the step to improve overall survival among ELBW infants is to overcome intestinal perforation requiring surgical management. Emergency laparotomy and diverting enterostomy for an intestinal perforation in ELBW infants are associated with a substantial risk of complications related to the stoma because of their extreme prematurity. Cyanoacrylate tissue adhesive has been used to seal wounds in accident and emergency departments, and to cover surgical wounds in the eyes
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