Minimizing Enterostomy Complication in Neonates, Lessons Learnt from Three European Tertiary Centres.

Riccardo Coletta,Antonino Morabito,Adrian Bianchi,Kathryn O’Shea,Elisa Mussi,Andrea Zulli

doi:10.3390/children9020162

Abstract

Introduction. Stoma formation in neonates is often a life-saving procedure across a variety of conditions but is still associated with significant morbidity. Tube stoma technique was originally described for short bowel patients, but in selected cases of neonates this approach could prevent the incidence of stoma-related complications. The aim of the study was to evaluate the safety and utility of tube stomas as an alternative to conventional enterostomy in the neonatal population. Material and Methods. A retrospective multicentre analysis of neonates undergoing emergency laparotomy and tube stoma formation between 2005 and 2017 was performed. Tube stoma complications were analysed. The investigation focused on stricture, skin lesion, enteric fistula and prolapse. Results. Thirty-seven neonates underwent tube stoma fashioning during the study period. Tube-stoma complications were limited to three patients (8.1%), with two children (5.4%) requiring additional stoma surgery during the first 30 days because of an enterocutaneous fistula, and one child (2.7%) for bowel stenosis. Conclusions. In select neonates, such as those with proximal enteric stomas, the tube stoma avoids some of the commonly encountered complications (prolapse, skin excoriation). Further prospective studies are needed to validate these findings in order for us to recommend this technique as superior.

Highlights

The diversionary double-barrel enterostomy commonly used in neonatal and paediatric surgery [1,2,3,4,5,6] carries an appreciable immediate and longer-term morbidity [7,8,9,10,11,12,13,14]
Tube-stoma complications w ited to three patients (8.1%), with two children (5.4%) requiring additional stoma duringadditional the firststoma
Enterostomy-related complications remain a significant cause of morbidity and occasional mortality with a published rate of 18–100% [3,5,6,7,13,14,18,19,20,21,22,23,24,25,26,27,28,29,30]

Summary

Introduction

The diversionary double-barrel enterostomy commonly used in neonatal and paediatric surgery [1,2,3,4,5,6] carries an appreciable immediate and longer-term morbidity [7,8,9,10,11,12,13,14]. In. 2006 Bianchi [15] proposed the ‘tube-stoma’ for controlled bowel expansion and output management for patients with a short bowel. The tube-stoma offers the advantages of not having any exposed bowel with uncontrollable effluent, eliminating contact of irritant fluids with the skin, reducing losses, and improving absorption by retaining nutrients in mucosal contact within the proximal bowel. Manual transfer of collected effluent from the proximal tube-stoma to a separate distal bowel tube-stoma provides an unique opportunity to ‘develop’ the defunctioned distal bowel by stimulating mucosal hyperplasia and increased absorption with reduction in fluid, electrolyte, and nutrient losses [16,17] prior to bowel reconstruction and/or stoma closure. We assess the ‘tube-stoma’ as a possible replacement for double-barrel enterostomy in selected circumstances. We assess the ‘tube-stoma’ as a possible replacement for double-barrel enterostomy in selected circumstances. 4.0/)

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