Recycling Small Intestinal Contents From Proximal Ileostomy in Low-Birth-Weight Infants With Small Bowel Perforation

Sutureless Loop Enterostomy in Very Low and Extremely Low Birth Weight Infants

Introduction Sutureless enterostomy is used as an effective technique for constructing an enterostomy in very low and extremely low birth weight infants in Japan. Sutureless enterostomy is a separate type of enterostomy procedure for low birth weight infants. We adapted this technique and developed sutureless loop enterostomy (SLE), an approach without a skin bridge in which the intestinal wall is not sutured to the abdominal wall. This study aimed to compare SLE outcomes with those of sutureless enterostomy (SE) and the conventional procedure (C). Methods We retrospectively reviewed clinical records of 32 very low or extremely low birth weight infants who underwent enterostomy and classified the infants into three groups according to the procedure: SLE, SE, and C. We compared surgery-related items and enterostomy-related complications between the three groups. Results We found no significant differences in sex, age at surgery, or surgical blood loss. The operation time was significantly shorter in the SLE group than in the C group (P < 0.05). The number of postoperative complications was not significantly different in the SLE group compared with the other two groups. Conclusion Sutureless loop enterostomy is an effective, safe procedure for enterostomy in very low and extremely low birth weight infants.

Mucous fistula refeeding in neonates: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Mucous fistula refeeding (MFR) aims to maximise bowel function when an ostomy is active after abdominal surgery, by introducing the proximal ostomy effluent into the distal mucous fistula to maintain intestinal physiology. The aim of the study was to assess the effectiveness and complications of MFR in neonates following abdominal surgery.

DESIGN, SETTING AND INTERVENTIONS

Systematic review and meta-analysis of randomised controlled trials and observational studies. PubMed, Embase, Cochrane and CINAHL were searched until June 2022 for studies including neonates with ostomy receiving MFR compared with neonates with ostomy without MFR.

OUTCOMES

The primary outcome was duration of parenteral nutrition. Secondary outcomes were time to full enteral feeds, rates of cholestasis, peak total serum bilirubin, sepsis, time to reanastomosis and length of hospital stay.

RESULTS

A total of 16 observational studies were included (n=623). Compared with comparator group, neonates who received MFR had fewer days of parenteral nutrition (mean difference 37.17 days, 95% CI -63.91 to -10.4, n=244, 5 studies, GRADE: low). In addition, neonates who received MFR had lower rates of cholestasis, shorter time to reach full feeds and shorter hospital stay.

CONCLUSION

Low certainty of evidence suggests that MFR is associated with shorter duration of parenteral nutrition in neonates following abdominal surgery and stoma creation. Results of ongoing and future randomised trials may help to corroborate these findings.

A review of chyme reinfusion: new tech solutions for age old problems

High-output double enterostomies (DES) and enteroatmospheric fistulae (EAF) are associated with significant morbidity, including infection, malnutrition, and prolonged hospital admissions. Management is complex and has remained a challenging surgical problem for many decades in both adult and paediatric patient populations. Chyme reinfusion (CR) from the proximal to distal DES or EAF limb is a potential therapeutic solution which has been shown to be safe and beneficial; however, early methods have involved the manual handling of chyme, which is labour intensive and poorly tolerated by both patients and staff. Over the past four decades, there has been growing interest in the application and development of medical device technology to improve the effectiveness and user-friendliness of CR. New Zealand (NZ) has been at the forefront of innovation in this field, with exciting translational research projects in both adults and neonates (funded and enabled by the NZ MedTech CORE). This narrative review provides a summary of the evolution of CR technology globally, synthesises the extant clinical evidence and highlights future directions.

Chyme recycling in the management of small bowel double enterostomy in pediatric and neonatal populations: A systematic review

BACKGROUND & AIMS

Intestinal failure (IF) in neonatal and pediatric patients is associated with substantial morbidity. Management of IF includes the formation of a double enterostomy (DES) of the small bowel. Parenteral nutrition (PN) is frequently required, which is expensive. Recycling chyme from the proximal DES limb distally is an alternative therapy, but standardized data on this intervention is lacking. This review systematically evaluated the existing literature on chyme recycling (CR) in neonatal and pediatric populations.

METHODS

Medical databases were systematically searched for articles reporting CR in neonatal and pediatric populations. Articles documenting CR indications, methods, clinical outcomes, benefits and adverse events (AEs) were reviewed. A narrative synthesis was performed on the extracted data.

RESULTS

This review identified 20 full-text articles, in which 289 patients received CR, most commonly following necrotizing enterocolitis (n = 117 patients). The most common motivators for CR were proximally located DES (n = 7 articles) and to support nutrition and growth (n = 7 articles). Proximal DES output collection was predominantly manual (n = 11 articles), whereas distal CR was mostly automated (n = 12 articles), using customized peristaltic or syringe infusion pumps. Clinical benefits encompassed PN reduction (n = 19 patients) or cessation (n = 122 patients), weight gain, normalization of fluid balance, improvement in liver function tests and distal gut maturation. Technical problems commonly included tube dislodgement, leakage and effluent reflux (n = 9 articles). AEs included intestinal perforation (n = 3 patients) and haemorrhage (n = 1 patient).

CONCLUSIONS

From the limited available data, CR is demonstrated as an effective therapeutic intervention for small bowel DES in pediatric and neonatal patients. However, standardized methods that improve the delivery of and minimise AEs associated with the intervention are needed.