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Early Versus Late Stoma Reversal in Children Presenting with Acute Abdomen
Abdullah Khan1, Muhammad Bilal Mirza1, Nabila Talat1
1Department of Paediatric Surgery Unit II, The Children's Hospital and University of Child Health Sciences, Lahore, Pakistan.
Insights
Early stoma reversal in children is safe, showing no increased risk of anastomotic leakage or surgical site infection compared to late reversal. This allows for timely stoma reversal without major complications.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Temporary stomas are common in pediatric surgery for various gastrointestinal conditions.
- Stoma reversal timing (early vs. late) can impact patient morbidity.
- Key complications include anastomotic leakage and surgical site infections.
Purpose of the Study:
- To compare the morbidity associated with early (same-admission) versus late (routine-interval) stoma reversal in children.
- To evaluate the incidence of anastomotic leakage and wound infections in both groups.
Main Methods:
- A quasi-experimental study involving 60 pediatric patients with temporary stomas.
- Patients were divided into two groups: early reversal (n=30) and late reversal (n=30, ≥2 months).
- Comparison of anastomotic leakage and surgical site infection rates using the Chi-square test.
Main Results:
- No anastomotic leakage occurred in either early or late reversal groups.
- Overall surgical site infection rates were similar, but minor infections (Southampton Grade I and II) were more frequent in the late reversal group.
- Early reversal patients were younger (median 12 months vs. 66 months), with comparable operative times.
Conclusions:
- Same-admission stoma reversal in children demonstrates comparable safety to routine-interval reversal regarding anastomotic leakage and surgical site infection.
- Early stoma reversal is a safe option for pediatric patients with temporary stomas, minimizing major complications.
Objective:
To determine the morbidity e.g., anastomotic leakage and wound infections, in children enduring early (same-admission) vs. late (routine-interval) stoma reversal.
Study Design:
A quasi-experimental study. Place and Duration of the Study: Department of Paediatric Surgery Unit II, The Children's Hospital and University of Child Health Sciences, Lahore, Pakistan, from February 2022 to March 2023.
Methodology:
This study enrolled 60 patients with an emergency temporary stoma, using a non-probability consecutive sampling technique. Among them, half of the patients (n = 30) underwent early stoma reversal (Group A), while the remaining half underwent the procedure after a routine interval of 2 months or more (Group B). The frequencies of anastomotic leakage and surgical site infection were compared using the Chi-square test.
Results:
In this study, 60 temporary ileostomy stomas were reversed. The group that underwent same-admission reversal compromised comparatively younger patients (median: 12 vs. 66 months). Both groups had mostly male patients. Operative time was also comparable in both groups. No cases of anastomotic leakage were observed in either group. The overall wound infection rate was similar in both groups; however, more patients in the routine-interval stoma reversal group experienced minor wound infections, Southampton Grade I and II.
Conclusion:
Stoma reversal during the same admission has shown a comparable rate of anastomotic leakage, surgical site infection, and operative time. Patients with an emergency temporary stoma can undergo stoma reversal in the early postoperative period without any major risk of complications.
Key Words:
Early stoma reversal, Routine interval stoma reversal, Surgical site infection, Anastomotic leak.
