Intestinal Anastomosis During Enterostomy Takedown Using a 5 mm Miniature Endostapler Compared to Conventional...

Area of Science:

• Pediatric Surgery
• Surgical Innovation
• Gastrointestinal Surgery

Background:

• Enterostomy takedown is a frequent procedure in neonates with conditions like Hirschsprung's disease, anorectal malformations, and necrotizing enterocolitis.
• Conventional intestinal staplers (12 mm diameter) are too large for enterostomy takedown in infants, necessitating alternative techniques.
• The advent of miniature (5 mm diameter) staplers has enabled their use in this pediatric population.

Purpose of the Study:

• To compare the efficacy and outcomes of enterostomy takedown using a miniature stapler (MS) versus the traditional hand-sewn (HS) technique in children under three years of age.
• To evaluate operative times, complication rates, and patient recovery metrics between the two techniques.

Main Methods:

• A retrospective review was conducted on 102 pediatric patients (<3 years) who underwent enterostomy closure between 2008 and 2023.
• Patients were categorized into two groups: those who underwent miniature stapler (MS) anastomosis (n=26) and those who had hand-sewn (HS) anastomosis (n=76).
• Demographic data, operative duration, complications, and recovery outcomes were compared between the MS and HS groups.

Main Results:

• The miniature stapler (MS) group demonstrated significantly shorter operative times (82.5 vs. 147 minutes, p < 0.001) compared to the hand-sewn (HS) group.
• Patients in the MS group experienced earlier initiation of feedings (2 vs. 4 days, p = 0.001) and a reduced length of hospital stay (6 vs. 17 days, p < 0.001).
• No significant differences were observed in patient age, sex, or the primary indication for the enterostomy between the two groups.

Conclusions:

• The 5 mm miniature stapler is an effective and advantageous tool for enterostomy takedown in young children, offering significant improvements over the hand-sewn technique.
• The use of the miniature stapler is associated with reduced operative time, earlier feeding, and shorter hospitalizations, which is particularly beneficial for medically fragile pediatric patients.
• Further prospective, randomized controlled trials are recommended to validate these findings and solidify the role of miniature staplers in pediatric enterostomy closure.