Related Experiment Videos
Bowel stomas in infants and children. A 5-year audit of 203 patients
1Department of Paediatric Surgery, University of Cape Town.
Insights
This 5-year audit of pediatric bowel stomas found that while complications occurred in 31% of formations, stoma closure had a low 4% complication rate. Meticulous surgical technique is crucial for minimizing issues in pediatric stoma care.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Audit
Background:
- Bowel stomas (small-bowel and colostomies) are common in pediatric surgery.
- Indications include anorectal malformations, Hirschsprung's disease, and necrotising enterocolitis.
- Stoma formation, management, and closure are significant aspects of pediatric surgical practice.
Purpose of the Study:
- To audit the formation, management, and closure of pediatric bowel stomas over a 5-year period.
- To identify complication rates and influencing factors.
- To emphasize the importance of meticulous surgical technique.
Main Methods:
- Retrospective audit of 203 pediatric patients undergoing stoma procedures.
- Data collection on stoma type, site, indications, complications, and closure outcomes.
- Analysis of complication rates associated with different stoma types and sites.
Main Results:
- 128 patients (63%) required stomas neonatally.
- Common indications: anorectal malformations (80), Hirschsprung's disease (65), necrotising enterocolitis (33).
- Overall complication rate: 31% (necrosis, bleeding, prolapse, wound sepsis). Transverse colon colostomies had highest prolapse (38%).
- Stoma closure had a low 4% complication rate (wound sepsis, leaks, stenosis).
Conclusions:
- Pediatric bowel stoma care involves significant surgical workload.
- Meticulous technique is essential for minimizing stoma formation and closure complications.
- Stoma closure is generally safe with a low complication incidence.
Abstract:
A 5-year audit of the formation, management and closure of small-bowel stomas and colostomies at Red Cross War Memorial Children's Hospital, Cape Town, is described. Of the 203 patients, 128 (63%) required the stroma in the neonatal period. Anorectal malformations (80), Hirschsprung's disease (65), necrotising enterocolitis (33), trauma (11) and neoplasm (5) comprised most of the indications. One hundred and thirty large-bowel stomas were sited in the proximal sigmoid and 37 in the transverse colon, all but 11 being divided with each end brought out through a short muscle cutting incision or through the laparotomy wound. Thirty-six ileostomies were performed and in 30 of these the stoma was sited in the wound. Complications, which included necrosis, bleeding, prolapse and wound sepsis, occurred in 31%. The colostomies sited in the transverse colon had the highest incidence of prolapse (38%). Neonatal stomas brought out in the wound had an acceptably low incidence of complications. Most stomas were temporary in nature. One hundred and eighty-eight were closed, all with excision and end-to-end intraperitoneal anastomosis. There was a 4% incidence of complications (5 would sepsis, 2 leaks, 1 stenosis). The formation, management and closure of bowel stomas represents a considerable section of the work of the paediatric surgeon. Correct meticulous technique is essential in keeping complications to a minimum.