Abstract
PurposeTo provide an overview of complications after ileostomy or colostomy procedures in children, and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation, Hirschsprung’s disease, pediatric intestinal pseudo-obstruction (PIPO)) and children without motility disorders (including necrotizing enterocolitis, anorectal malformation and inflammatory bowel disease). MethodsWe performed a retrospective study of children who underwent an enterostomy procedure at our institution. The number and type of complications and subsequent reoperations after ostomy formation were determined. Complications were scored using the Clavien–Dindo classification. A complication of ≥ grade III-b was considered a high-grade complication. Results129 children with an ileostomy and 61 children with a colostomy were included. Of these, 62 children (32.6%) had motility disorders; functional constipation (n=40), Hirschsprung’s disease (n=18) and PIPO (n=4). The total prevalence of complications was 73.2%. Comparing the perioperative data, children with motility disorders significantly more often underwent a laparoscopic procedure (59.7% vs. 10.9%, p=0.000) and had an end stoma-configuration (37.1% vs. 14.1%, p=0.000) as compared to children without motility disorders. Children with motility problems had a higher complication rate (88.7% vs. 65.5%, OR 4.1, 95% CI 1.7–9.8, p=0.001) compared to children without motility problems, and a larger proportion of complications was classified as high-grade complications (61.8% vs. 31.0% p =0.002). ConclusionA high complication rate after enterostomy formation was detected. Children with gastrointestinal motility disorders had more and more severe complications as compared to children without motility disorders. Level of evidenceLevel III Type of studyRetrospective comparative study
Highlights
To provide an overview of complications after ileostomy or colostomy procedures in children, and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation, Hirschsprung’s disease, pediatric intestinal pseudo-obstruction (PIPO)) and children without motility disorders
The aim of this study was to provide an overview of the complication rate after ileostomy or colostomy procedures at our tertiary children’s hospital and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation (FC), Hirschsprung’s disease and pediatric intestinal pseudo obstruction (PIPO)) and patients with other indications
The majority of patients were less than one year of age at the time of initial surgery and included patients with necrotizing enterocolitis (NEC) (15.8%), anorectal malformations (13.7%) and Hirschsprung’s disease (9.5%)
Summary
To provide an overview of complications after ileostomy or colostomy procedures in children, and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation, Hirschsprung’s disease, pediatric intestinal pseudo-obstruction (PIPO)) and children without motility disorders (including necrotizing enterocolitis, anorectal malformation and inflammatory bowel disease). Stoma formation is used to manage a wide variety of conditions in children This includes two types of diverting enterostomies: ileostomies, with the surgically created opening in the small bowel, and colostomies, with the stoma formation in the large bowel. Several studies in young infants with Hirschsprung’s disease, anorectal malformations and NEC describe a stoma-related complication rate between 23% and 42% [9,10,11,12,13,14,15]. There have been no controlled studies comparing ostomy-related complications in pediatric patients with and without motility disorders
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