Abstract
PurposeThe optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necrotizing enterocolitis.MethodsPubMed, EMbase, Web-of-Science, and Cinahl were searched for studies that detailed time to ostomy closure, and time to full enteral nutrition (FEN) or complications after ostomy closure. Patients with Hirschsprung’s disease or anorectal malformations were excluded. Analysis was performed using SPSS 17 and RevMan 5.ResultsOf 778 retrieved articles, 5 met the inclusion criteria. The median score for study quality was 9 [range 8–14 on a scale of 0 to 32 points (Downs and Black, J Epidemiol Community Health 52:377–384, 1998)]. One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027). Four studies reported complication rates after ostomy closure, complications occurred in 27 % of the EC group versus 23 % of the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95 % CI 0.5, 2.5].ConclusionEvidence that supports early or late closure is scarce and the published articles are of poor quality. There is no significant difference between EC versus LC in the complication rate. This systematic review supports neither early nor late ostomy closure.
Highlights
Ostomy formation is inevitable in certain cases, for example in almost half the patients operated on for necrotizing enterocolitis (NEC) [1]
Premature infants are at a high risk; in patients with necrotizing enterocolitis, lower gestational age and birth weight were associated with greater risk of ostomy related complications [3]
Four studies compared complication rates after ostomy closure and only one study focused on mean time to full enteral nutrition after ostomy closure
Summary
Ostomy formation is inevitable in certain cases, for example in almost half the patients operated on for necrotizing enterocolitis (NEC) [1]. In 15–68 % of cases ostomy-related complications may occur, such as stricture, parastomal hernia, prolapse, wound infection, wound fistula, wound dehiscence, and small bowel obstruction [2,3,4,5]. Premature infants are at a high risk; in patients with necrotizing enterocolitis, lower gestational age and birth weight were associated with greater risk of ostomy related complications [3]. Subsequent ostomy closure carries a complication rate of about 20 %, including wound infection, wound dehiscence, enterocutaneous fistula, bowel obstruction, anastomotic leak, and anastomotic stricture [2, 5, 6]. Ostomy closure during the same hospital admission is favorable for parents and caregivers
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