Neonatal stomas: does a separate incision avoid complications and a full laparotomy at closure?

Pediatr Surg Int. 2013 Mar;29(3):299-303. doi: 10.1007/s00383-012-3234-z. Epub 2012 Dec 20.

Abstract

Purpose: Enterostomy formation is a common outcome in emergency neonatal laparotomy. No consensus exists regarding optimal stoma site. This study aims to identify incidence of complications and closure details related to position of stomas.

Methods: This study is a retrospective case note review of emergency neonatal enterostomy formation over 11 years at a single institution. Patients were separated into two groups: stomas created through the laparotomy wound and stomas created through a separate incision. Demographic details, complications and closure details were ascertained. Differences between groups were analysed (Mann-Whitney test for continuous variables, Chi-squared test or Fisher's exact test for categorical variables).

Results: One hundred and thirteen stoma formations were examined in 106 patients (71 within laparotomy wound, 42 through a separate incision). Age, gestation, weight, wound-related and stoma-related complications were not significantly different between the groups. A trend towards a higher rate of full laparotomy at closure with stomas through the wound (p = 0.09) was seen. If stomas were sited adjacently, there was no difference in avoidance of full laparotomy at closure (p = 0.97).

Conclusion: Stomas sited adjacently within the laparotomy wound are not related to increased complications and offer the same advantage of circumexcision at closure as stomas sited through a separate wound, without an additional abdominal wound.

MeSH terms

  • Biliary Atresia / surgery
  • Emergencies
  • Enterocolitis, Necrotizing / surgery
  • Enterostomy / methods*
  • Hirschsprung Disease / surgery
  • Humans
  • Ileus / surgery
  • Infant, Newborn
  • Laparotomy*
  • Meconium
  • Postoperative Complications*
  • Retrospective Studies