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Ostomy Creation in Neonates with Acute Abdominal Disease: Friend or Foe
European Journal of Pediatric Surgery, 08/17/2012
Van Zoonen AGJF et al. – Although creating a temporary ostomy in newborns is preferable in certain situations, there is a considerable occurrence of complications and reoperations.
Methods- All data regarding neonates (<30 days of age) who underwent a laparotomy for a suspected abdominal emergency in the period 2000 to 2010 were retrospectively analyzed.
- These data included demographics such as gender, gestational age, and birth weight.
- Disease etiology was defined and various features of the enterostomy were analyzed.
- These features included type, location, time to ostomy take down, and complications and mortality directly related to both creation and closure of the ostomy.
- A total of 155 patients who underwent a laparotomy for suspect acute abdomen were identified. Median gestational age was 33 weeks (range 25 to 40) and median birth weight was 1926 g (range 560 to 4380).
- Median age at laparotomy was 8 days (range 0 to 30). Indications for surgery were necrotizing enterocolitis (n = 38), spontaneous intestinal perforation (n = 11), intestinal atresia (n = 9) or obstruction (n = 5), and volvulus (n = 4).
- An ostomy was created in 67 patients (67/155: 43%): 38 boys and 29 girls. There were 8 jejuno-, 49 ileo-, and 10 colostomies created. In almost all cases (94%), a mucous fistula was also constructed.
- In this study, 11 patients died before ostomy closure could occur. In 53 patients, the ostomy was closed after a median of 107 days (range 4 to 299).
- After ostomy closure, complications occurred in 13 cases (13/53: 25%).
- Seven patients (7/53: 13%) needed another reoperation because of anastomotic leakage (n = 4), adhesions (n = 2), or incisional hernia (n = 1).
- There was no closure-related mortality.
