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Sutureless enterostomy for extremely low birth weight infants
Kensuke Ohashi1, Tsugumichi Koshinaga1, Shuichiro Uehara1
1Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
Insights
A new sutureless enterostomy technique safely reduces stoma complications in extremely low birth weight infants (ELBWIs) with meconium obstruction of prematurity (MOP) or spontaneous intestinal perforation (SIP). This method offers a promising alternative for high-risk neonates.
Area of Science:
- Neonatal Surgery
- Pediatric Surgery
- Gastroenterology
Background:
- Improved survival rates in extremely low birth weight infants (ELBWIs) have increased the incidence of enterostomy for conditions like meconium obstruction of prematurity (MOP) and spontaneous intestinal perforation (SIP).
- Stoma-related complications pose significant risks to these vulnerable infants, including perforation, prolapse, and surgical site infections.
Purpose of the Study:
- To introduce and evaluate a novel "sutureless enterostomy" technique designed to mitigate stoma-related complications in ELBWIs.
- To assess the safety and efficacy of this new surgical approach.
Main Methods:
- A retrospective review of medical records for twelve ELBWIs who underwent the "sutureless enterostomy" procedure between 2007 and 2013.
- Detailed analysis of patient demographics, surgical parameters, stoma-related complications, and patient outcomes.
Main Results:
- The study included infants with a mean birth weight of 671±158g, diagnosed with MOP (6 cases), SIP (3 cases), and necrotizing enterocolitis (NEC) (3 cases).
- No early stoma-related complications such as necrosis, fall, or surgical site infection were observed.
- One case of parastomal hernia occurred as a late complication. Three postoperative deaths were attributed to underlying condition exacerbations.
Conclusions:
- The "sutureless enterostomy" technique was demonstrated to be safe and effective in reducing the incidence of early stoma-related complications in ELBWIs.
- This innovative procedure shows potential as an ideal surgical option for ELBWIs suffering from MOP or SIP.
Objective:
In recent years, improved survival rates of extremely low birth weight infants (ELBWIs) have led to an increasing number of enterostomy performed for those with meconium obstruction of prematurity (MOP)1,2, spontaneous intestinal perforation (SIP)3,4. To prevent serious stoma-related complications such as stoma side perforation, prolapse, fall and surgical site infection, we introduce our new "sutureless enterostomy" technique.
Methods:
We present the procedures in detail. We reviewed the medical records of twelve patients who underwent "sutureless enterostomy" in our neonatal intensive care unit from 2007 to 2013. Patient attributes, surgery-related items, stoma-related complications and outcomes were investigated.
Results:
Mean birth weight was 671±158g (mean±S.D.). Six cases of MOP, three cases of SIP and three cases of NEC were diagnosed. Mean operative time was 75±35min (mean±S.D.) None of them presented any of early stoma-related complications (necrosis, fall, and surgical site infection). However the parastomal hernia occurred in one patient as late complication. Three deaths occurred postoperatively as a result of exacerbations of their conditions.
Conclusions:
Based on our preliminary observations, our new "sutureless enterostomy" was done safely and reduced the risk of stoma-related complications. It may be an ideal procedure for the ELBWI with MOP or SIP.
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