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Lin Z, Liu M, Yan L, Wu L, Bai J, Wu D, Fang Y, Lin Y. Outcome of Santulli enterostomy in patients with immaturity of ganglia: single institutional experience from a case series. BMC Surg 2022; 22:400. [DOI: 10.1186/s12893-022-01849-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Immaturity of ganglia (IG) is an extremely rare disease and always requires surgical intervention in the neonatal period, but without guidelines to choose the ideal enterostomy procedure, the timing of stoma closure remains controversial. The aim of this study was to report our experience using Santulli enterostomy for the treatment of nine infants diagnosed with IG.
Methods
Patients who underwent Santulli enterostomy and were diagnosed with IG in our center between 2016 and 2021 were retrospectively studied. Temporary stoma occlusion and a 24-h delayed film of barium enema (BE) were performed to evaluate intestinal peristalsis function to determine the timing of stoma closure. The demographic data, clinical and radiological findings, stoma occlusion and stoma closure results were explored.
Results
A total of 9 infants underwent Santulli enterostomy and were diagnosed with IG postoperatively. Their median gestational age at birth was 36 weeks (range 31–42), and their median birth weight was 2765 g (range 1300–3400). All patients had symptom onset in the neonatal period, including abdominal distension and biliary vomiting. Eight patients showed obvious small bowel dilatation in the plain films, except for one patient’s films that suggested gastrointestinal perforation with free gas downstream of the diaphragm. BE was performed in 6 patients, all of which had microcolons. The median age at operation was 3 days (range 1–23). Seven patients had an obvious transitional zone (TZ) during laparotomy, and the position of the TZ was 25–100 cm proximal above the ileocecal (IC) valve. Immature ganglion cells were present in the colon in 7 patients and the terminal ileum in 6 patients. The median age of successful stoma occlusion was 5 M (range 2–17) and 8 M (range 4–22) at ostomy closure. There was little or no barium residue in the 24-h delayed film of BE before stoma closure, and all patients were free of constipation symptoms during the follow-up.
Conclusion
Santulli enterostomy appears to be a suitable and efficient procedure for IG, combined with temporary stoma occlusion and 24-h delayed film of BE to evaluate the recovery of intestinal peristalsis function.
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Lin Y, Wu D, Shen Y, He Y, Ye J. Comparison of Outcomes between Two Surgical Techniques for Patients with Intestinal Neuronal Dysplasia. J Immunol Res 2022; 2022:9165651. [PMID: 35910855 PMCID: PMC9334036 DOI: 10.1155/2022/9165651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Hirschsprung disease (HSCR) is a serious congenital intestinal disease with a prevalence of 1/5000. HSCR remains one of the most severe congenital malformations of the abdominal organs in children that require complex reconstructive surgery. This study is aimed at investigating the clinical analysis of ileal Santulli stoma and ileal double-lumen stoma in children diagnosed with intestinal neuronal dysplasia (IND). Methods Retrospective analysis was performed on the children who were admitted to our hospital for intestinal obstruction from January 2014 to January 2019, underwent fistula operation and fistula closure operation, and were diagnosed with IND. According to the different modes of fistula, the children were divided into ileal Santulli stoma group and ileal double-lumen stoma group. The body weight of the children in the two groups during the second stage of fistula closure operation was compared. The number of hospitalizations due to enteritis and dehydration during the two operations was compared. Results A total of 23 cases (12 males and 11 females) were included in this study, including 10 cases in the Santulli group and 13 cases in the ileal double-lumen stoma group. There were no significant differences in baseline data and fistula location between the two groups. Compared with the ileal double-lumen stoma group, the Santulli stoma group had significantly higher weight of fistula precursor (P < 0.05), the interval between two operations was shorter (P < 0.05), there is less hospitalization for enteritis and dehydration during the two operations (P < 0.05), and there is less economic cost after fistula (P < 0.05). Conclusion The clinical effect of ileum Santulli fistula is significantly better than double-lumen ileum fistula, which is not only beneficial to the growth and development of children after the first fistula but also can shorten the time of fistula closure, reduce the incidence of dehydration, and reduce the economic burden of family members. Therefore, it is worthy of clinical promotion and application.
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Affiliation(s)
- Yu Lin
- Pediatric Surgery Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350000 Fujian, China
| | - Dianming Wu
- Pediatric Surgery Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350000 Fujian, China
| | - Yong Shen
- Pediatric Surgery Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350000 Fujian, China
| | - Yuanbin He
- Pediatric Surgery Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350000 Fujian, China
| | - Jianxin Ye
- Department of Gastrointestinal Surgery 2 Section, The First Hospital Affiliated to Fujian Medical University, Fuzhou, 350000 Fujian, China
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Complex gastroschisis with apple peel jejunoileal atresia, primary closure, and Santulli procedure as a surgical alternative. Case report. Int J Surg Case Rep 2022; 94:107095. [PMID: 35461184 PMCID: PMC9046871 DOI: 10.1016/j.ijscr.2022.107095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Gastroschisis is a closure defect of the abdominal wall classified as complex when it presents with necrosis, volvulus, or atresia of the gastrointestinal tract. Jejunoileal atresia is caused by abnormal closure, discontinuity, or narrowing of the intestine. Apple Peel or type IIIb is the rarest presentation, with an incidence of 1.3 per 10,000 live births. In addition to presenting a high mortality rate. PRESENTATION OF CASE We present a preterm newborn patient of 30 weeks with a diagnosis of gastroschisis and jejunoileal atresia type IIIB. The congenital wall defect was closed in the first surgical stage, and he was then taken at four weeks to correct the atresia. In the second surgery, we found a difference in intestinal calibers of 8:1, and the surgical team decides to perform remodeling of the proximal sac with a mechanical stapler and perform anastomosis using the Santulli technique. On day 6 of life, enteral feeding began through a nutrition tube localized under intestinal anastomosis with progressive nutritional increase. Subsequently, intermittent and progressive occlusion of the stoma was performed, leading the patient to a definitive surgical closure one month later. CONCLUSIONS The mortality rate for gastroschisis and complex intestinal atresia is high. Advances in prenatal diagnosis, neonatal intensive care, and proper surgical correction are crucial to improving survival rates. The Santulli procedure is a surgical alternative for intestinal atresias with a caliber discrepancy greater than 4 to 1 or when the characteristics of the distal part do not allow a primary anastomosis to be performed.
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Coletta R, Zulli A, O’Shea K, Mussi E, Bianchi A, Morabito A. Minimizing Enterostomy Complication in Neonates, Lessons Learnt from Three European Tertiary Centres. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020162. [PMID: 35204883 PMCID: PMC8870697 DOI: 10.3390/children9020162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/22/2022]
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.
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Affiliation(s)
- Riccardo Coletta
- Department of Paediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.Z.); (A.M.)
- School of Environment and Life Science, University of Salford, Salford M5 4NT, UK
- Correspondence:
| | - Andrea Zulli
- Department of Paediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.Z.); (A.M.)
- Department of Neurofarba, University of Florence, Viale Pieraccini 6, 50121 Florence, Italy
| | - Kathryn O’Shea
- Department of Paediatric Surgery, Royal Manchester Children’s Hospital, Manchester M13 9WL, UK;
| | - Elisa Mussi
- Department of Industrial Engineering, University of Florence, 50139 Florence, Italy;
| | - Adrian Bianchi
- Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK;
| | - Antonino Morabito
- Department of Paediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (A.Z.); (A.M.)
- Department of Neurofarba, University of Florence, Viale Pieraccini 6, 50121 Florence, Italy
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Vinit N, Rousseau V, Broch A, Khen-Dunlop N, Hachem T, Goulet O, Sarnacki S, Beaudoin S. Santulli Procedure Revisited in Congenital Intestinal Malformations and Postnatal Intestinal Injuries: Preliminary Report of Experience. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9010084. [PMID: 35053709 PMCID: PMC8774359 DOI: 10.3390/children9010084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
In our experience, the Santulli procedure (SP) can improve bowel recovery in congenital intestinal malformations, necrotizing enterocolitis (NEC), and bowel perforation. All cases managed at our institution using SP between 2012 and 2017 were included in this study. Forty-one patients underwent SP (median age: 39 (0-335) days, median weight: 2987 (1400-8100) g) for intestinal atresia (51%, two gastroschisis), NEC (29%), midgut volvulus (10%), Hirschsprung's disease (5%), or bowel perforation (5%), with at least one intestinal suture below the Santulli in 10% of cases. The SP was performed as a primary procedure (57%) or as a double-ileostomy reversal. Anal-stool passing occurred within a median of 9 (2-36) days for 95% of patients, regardless of the diversion level or the underlying disease. All three patients requiring repeated surgery for Santulli dysfunction had presented with stoma prolapse (p < 0.01). Stoma closure was performed after a median of 45 (14-270) days allowing efficient transit after a median of 2 (1-6) days. After a median follow-up of 2.9 (0.7-7.2) years, two patients died (cardiopathy and brain hemorrhage), full oral intake had been achieved in 90% of patients, and all survivors had normal bowel movement. Whether used as primary or secondary surgery, the SP allows rapid recovery of intestinal motility and function.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France; (N.V.); (V.R.); (A.B.); (N.K.-D.); (S.S.)
- Faculté de Médecine Paris Centre, Université de Paris, 75006 Paris, France;
| | - Véronique Rousseau
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France; (N.V.); (V.R.); (A.B.); (N.K.-D.); (S.S.)
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France; (N.V.); (V.R.); (A.B.); (N.K.-D.); (S.S.)
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France; (N.V.); (V.R.); (A.B.); (N.K.-D.); (S.S.)
- Faculté de Médecine Paris Centre, Université de Paris, 75006 Paris, France;
| | - Taymme Hachem
- Department of Neonatology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France;
| | - Olivier Goulet
- Faculté de Médecine Paris Centre, Université de Paris, 75006 Paris, France;
- Department of Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France; (N.V.); (V.R.); (A.B.); (N.K.-D.); (S.S.)
- Faculté de Médecine Paris Centre, Université de Paris, 75006 Paris, France;
| | - Sylvie Beaudoin
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France; (N.V.); (V.R.); (A.B.); (N.K.-D.); (S.S.)
- Faculté de Médecine Paris Centre, Université de Paris, 75006 Paris, France;
- Correspondence: ; Tel.: +33-(0)1-7119-6297
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Yue M, Yang H, Cui M, Yuan Y, Zhang N, Zhang X, Li Y. The safety and effectiveness of Santulli enterostomy in neonatal intestinal conditions. Front Pediatr 2022; 10:1077346. [PMID: 36683787 PMCID: PMC9845765 DOI: 10.3389/fped.2022.1077346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND As an end stoma, Santulli enterostomy provides early restoration of intestinal continuity without formal laparotomy. Short amputation of the common limb enables closure on a side to restore anatomic continuity without sacrificing valuable intestine; additionally, the procedure is simple and safe. Most newborns who require enterostomy might benefit from Santulli enterostomy; however, several pediatric surgeons lack information regarding this procedure. Therefore, we have reviewed our experience about Santulli enterostomy and explore the advantages and indications in neonatal intestinal conditions. METHODS The clinical data of 76 neonates who underwent enterostomywere obtained. The patients were divided into two groups: the Santulli group with 33 cases who underwent Santulli enterostomy, and the control group with 43 cases who underwent double- or single-lumen ostomy. The general data of the two groups were analyzed, and the perioperative/postoperative complications, clinical data and the long-term outcomes were compared. RESULTS There was no difference in the demographic informations, the level of enterostomy, the rate of high-sight stoma, the operative time and bleeding of enterostomy between the two groups. Compared to the control group, the operative time of ostomy closure was less in the Santulli group (53.00 vs. 152.47, P < 0.001). The duration of parenteral nutrition (27.45 vs. 44.56, P = 0.010), the mean interval of initial enterostomy to stomal closure (131.21 vs. 216.42, P < 0.001), and length of stay (46.00 vs. 67.60, P = 0.007) were shorter, while the incidence of postoperative complications and hospitalization costs (11.21 vs. 15.49, P = 0.006) were lower. The Santulli procedure can reduce the morbidity of high output ostomy (2 vs. 10, P = 0.042) and short bowel syndrome (3 vs. 132, P = 0.025), shorten the discrepancy of diameter between the proximal and distal segments, maximize the available intestine, and monitor the movement of the distal bowel. The length of incision was shorter, and the catch-up growth was significantly faster in the Santulli group. CONCLUSION Santulli enterostomy is a superior procedure in the treatment of neonatal intestinal conditions, in terms of fewer complications, faster catch-up growth, shorter hospitalization time and treatment duration. It should be the procedure of choice in several newborns with intestinal conditions that require ostomy.
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Affiliation(s)
- Ming Yue
- Pediatric Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Heying Yang
- Pediatric Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingxia Cui
- Pediatric Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuhang Yuan
- Pediatric Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ning Zhang
- Pediatric Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangyu Zhang
- Pediatric Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Li
- Pediatric Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Martynov I, Raedecke J, Klima-Frysch J, Kluwe W, Schoenberger J. The outcome of Bishop-Koop procedure compared to divided stoma in neonates with meconium ileus, congenital intestinal atresia and necrotizing enterocolitis. Medicine (Baltimore) 2019; 98:e16304. [PMID: 31277168 PMCID: PMC6635230 DOI: 10.1097/md.0000000000016304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To determine the potential value and suitability of Bishop-Koop procedure (BK) compared to divided stoma (DS) in neonates with meconium ileus (MI), congenital intestinal atresia (CIA), and necrotizing enterocolitis (NEC).A retrospective data collection from 2000 to 2019 on neonates undergoing BK and DS formation and closure for MI, CIA, and NEC was conducted. Ostomy related complications following both procedures were analyzed.One hundred two consecutive patients managed with a BK (n = 57, 55.8%) and DS (n = 45, 44.2%) for MI (n = 38, 37.2%), CIA (n = 31, 30.5%), and NEC (n = 33, 32.3%) were analyzed. Mean operating time for ostomy creation did not differ significantly between BK and DS groups (156 ± 54 vs 135 ± 66.8 min, P = .08). The prevalence of stoma-related complications following BK and DS formation was 8.7% and 31.1%, respectively (P = .005). The complication rate after BK and DS closure was 3.5% and 6.7%, respectively (P = .65). The operating time for ostomy reversal and length of hospital stay after stoma closure were significantly shorter in BK group (82.2 ± 51.4 vs 183 ± 84.5 min and 5.5 ± 2.7 vs 11.3 ± 3.9 days, P < .001).BK procedure is safe, reliable, and suitable technique in neonatal surgery with low complications rate following ostomy creation as well as shorter operating time and length of hospital stay after ostomy closure compared to DS ostomies. Surgeons should keep this technique as an alternative approach in their repertoire.
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Affiliation(s)
- Illya Martynov
- Department of Pediatric Surgery, University of Leipzig, Leipzig
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Jochen Raedecke
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Jessica Klima-Frysch
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Wolfram Kluwe
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Joachim Schoenberger
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
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Loss of intestine during stoma closure: an experimental model comparing laparoscopic and conventional techniques. Pediatr Surg Int 2010; 26:119-21. [PMID: 19855979 DOI: 10.1007/s00383-009-2513-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study compared laparoscopy-assisted stoma closure (Lap) with conventional closure (Co) to assess loss of intestine. METHODS Ileostomies (loop L; single S) were performed 5 cm proximal to the ileocecal junction through a right lower quadrant incision in forty 11-week-old Lewis rats (L = 20, S = 20). Stoma closure was performed 60 days later using laparoscopy (Lap) or conventional closure (Co) in 10 rats each, to give 4 groups, Lap-L, Lap-S, Co-L, and Co-S. End-to-end anastomosis was performed through the stoma site in all rats. Bowel resected from the skin to the anastomosis was termed resected unusable bowel (RUB) and measured blindly. Laparotomy was performed 30 days later to assess the status of the anastomosis and complications. RESULTS Average RUB with Lap was significantly shorter; Lap-L (17.8 mm) versus Co-L (23.8 mm), P = 0.002, and Lap-S (10.6 mm) versus Co-S (13.8 mm), P = 0.001. During Co, accidental full-thickness injury to underlying bowel during stoma take-down occurred in 3 Co-L and 2 Co-S rats. All Lap rats were uncomplicated. Average times taken until end of stoma take-down were 6.1 min for Lap-L (3.2 min for trocar insertion, 2.8 min for stoma take-down), 5.6 min for Lap-S (2.8 and 2.7 min), 6.3 min for Co-L (from first incision to stoma take-down), and 5.1 min for Co-S (P = NS). At laparotomy there was no evidence of complications such as wound infection, incisional hernia or anastomotic stenosis in any rat. CONCLUSIONS Our results suggest that laparoscopy-assisted stoma closure is safe and quick, and results in less loss of intestine during stoma closure.
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Rygl M, Pycha K, Stranak Z, Skaba R, Brabec R, Cunat V, Snajdauf J. T-tube ileostomy for intestinal perforation in extremely low birth weight neonates. Pediatr Surg Int 2007; 23:685-8. [PMID: 17486355 DOI: 10.1007/s00383-007-1931-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2007] [Indexed: 11/28/2022]
Abstract
To evaluate the results of use of T-tube ileostomy in selected cases of intestinal perforation in extremely low birth weight (ELBW) neonates. The records of 288 ELBW neonates treated at author's institution, from 1998 to 2003 were retrospectively reviewed to identify neonates operated for intestinal perforation with T-tube placement. T-tube was inserted into the bowel through the site of perforation or proximally to the perforated gut via separate stab incision. T-tubes were used in five ELBW neonates (BW 600-900 g, gestational age 25-27 weeks) with intestinal perforation, in four of them at the time of primary surgery and in one neonate 8 days after primary anastomosis. All patients survived and there were no serious complications related to the T-tube insertion. Median duration of T-tube placement was 4 weeks (range 3-8 weeks), full enteral feeding after T-tube insertion was achieved in 4 weeks (range 1-6 weeks). All sites of T-tube insertion closed spontaneously. T-tube ileostomy is an effective and safe technique for treatment of selected cases of intestinal perforation in ELBW neonates. With respect to the hypoperistalsis of immature bowel, we recommend the use of T-tube in all cases of isolated intestinal perforation in ELWB neonates.
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Affiliation(s)
- M Rygl
- Department of Pediatric Surgery, 2nd Faculty of Medicine and Teaching Hospital in Motol, Institute of Postgraduate Medicine, Charles University, V Uvalu 84, Prague 5, Czech Republic.
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Mandhan P, McConchie B, Brown S, Kukkady A, Samarakkody U. Comparative study between window and conventional enterostomies in preterm neonates with small bowel perforations. J Pediatr Surg 2007; 42:823-8. [PMID: 17502192 DOI: 10.1016/j.jpedsurg.2006.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Small bowel perforations in the neonatal period can be secondary to necrotizing enterocolitis (NEC), ischemic necrosis, or occlusive anomalies of the small bowel; furthermore, they may be of no discernible cause. Depending on the clinical condition of the infant and the extent of the disease, a number of surgical options are available; one of which is exteriorization. To reduce the morbidity of stoma among patients, we adopted a technique called window enterostomy (WEnt). The objectives of this study were to describe the technique and to compare WEnt with conventional enterostomy (CEnt) in preterm infants undergoing surgery for focal NEC or isolated small bowel perforation (ISBP). METHODS We reviewed all cases of NEC and ISBP between January 1996 and March 2006 from our institution. Patients with focal NEC or ISBP who required a surgical intervention were included and categorized into the WEnt and the CEnt groups. We collected multiple data as study variables: demographics; site of perforation; operative time; need for a second operation; postoperative morbidity; duration of total parenteral nutrition; and postoperative weight gain. RESULTS Twenty-four neonates met the criteria for study inclusion. Of these, 14 underwent CEnt and 10 underwent WEnt. The median gestational age and birth weight of the neonates were 25.4 weeks (SD = 1.4) and 814.4 g (SD = 195.1), respectively. In comparing the 2 groups, we found statistically significant differences in the operative time for the primary and secondary procedures, duration of total parenteral nutrition, time to full oral feeding, and weekly postoperative weight gain. The rate of postoperative complications was higher among the infants from the CEnt group. CONCLUSION Our results suggest that WEnt is a quick and workable technique with minimal morbidity for preterm neonates with focal NEC or ISBP.
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Affiliation(s)
- Parkash Mandhan
- Department of Pediatric Surgery, Waikato Hospital, Hamilton 3240, New Zealand
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