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

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 III, and 37 (57%) - by CDC of grade ≥III. Stomas were closed in 32 children (39.5%) after 35 days, on average (6-126 days). Mortality was 28.4%, mainly in children weighing less than 1000 gramm (p = 0.03).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.