A Multi-Institutional Study Comparing Stoma Location in Neonates With Intestinal Perforation

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Surgical Outcomes

Background:

• Neonates with intestinal perforation often require surgical intervention including stoma creation.
• Stoma placement can be within the laparotomy incision or at a separate site.
• The impact of stoma location on postoperative wound complications is not well-established.

Purpose of the Study:

• To investigate the association between stoma location and the risk of postoperative wound complications in neonates.
• To identify factors influencing wound complications after intestinal stoma creation in infants.

Main Methods:

• Multi-institutional retrospective review of neonates (≤3 months) undergoing emergent laparotomy and intestinal stoma creation for intestinal perforation.
• Patients were stratified by stoma location: laparotomy incision versus separate site.
• Outcomes analyzed included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression was used to identify associated factors.

Main Results:

• A total of 79 neonates were included, with stomas placed in the laparotomy incision for 51.9% and separate sites for 48.1%.
• No significant differences in wound infection/dehiscence, peristomal irritation, stoma retraction, or stoma stricture were observed between the two groups.
• Separate site stomas were associated with an increased likelihood of stoma prolapse (odds ratio 6.54).

Conclusions:

• Incorporating the stoma within the laparotomy incision does not increase the risk of wound complications in neonates.
• Stoma placement at a separate site may be linked to a higher incidence of stoma prolapse.
• Individual patient factors should guide the decision-making process for optimal stoma site selection in neonates undergoing surgery for intestinal perforation.