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Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technica...
Contexts in source publication
Context 1
... that allows the surgeon to identify the correct dis- section plane, remaining as close as possible to the bowel wall (Figs. 1, 5), careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a precise anastomosis (Figs. 2, 5); a two-layer, end-to-end anastomosis with separated long-term 6-0 absorbable sutures (Figs. 3, 5), generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure in layers to avoid dead space, avoidance of hematomas, and wound coverage with collodium (Figs. 4, 5). In the postoperative, no nasogastric tubes were used, and the patients received clear fluids on the first postoperative day, if they ...
Context 2
... edge of the stomas to allow a precise anastomosis (Figs. 2, 5); a two-layer, end-to-end anastomosis with separated long-term 6-0 absorbable sutures (Figs. 3, 5), generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure in layers to avoid dead space, avoidance of hematomas, and wound coverage with collodium (Figs. 4, 5). In the postoperative, no nasogastric tubes were used, and the patients received clear fluids on the first postoperative day, if they were not distended or nauseated. Most of the patients were discharged home on the second or third day following the ...
Citations
... This rate correlates to that of other published series of colostomy formation in ARM [41,42]. Stoma closure may also incur further complications; and while not assessed specifically in this cohort, these occurred in up to 45% in a large published series from Cincinnati Children's Hospital [43]. Performing staged repair also increases the number of general anaesthetics children undergo (i.e. 3 versus 1) [44]. ...
... performed 24 h before the scheduled surgery. [1] MBP usually necessitates the nasogastric tube (NGT) insertion in children due to noncompliance with the standard method which increases the patient's discomfort. The complications of the stoma closure procedure include wound infection, incisional hernia, anastomotic leaks, and death [3] and there is considerable variation in the practices of antibiotic usage, abdominal closure methodology, and the time frame for NG tube removal and oral feeding initiation after stoma closure. ...
... There are various indications for temporary stomas in children, including anorectal malformations (ARMs), Hirschsprung's disease (HD), necrotizing enterocolitis, and intestinal atresia. [1] Preoperative mechanical bowel preparation (MBP) in colonic and rectal surgeries has been the standard of care for decades. MBP can be used in combination with preoperative oral antibiotics (OAB) and intravenous antibiotics. ...
... We follow standard operative procedure steps for stoma closure which included the administration of IV antibiotics at induction of anesthesia. [1] The patients are admitted one day before surgery. The patients are kept fasting for 6 h for food and formula, 4 h for breast milk, and 2 h for clear fluid. ...
Introduction:
Stoma closure is one of the most frequently performed surgical procedures by pediatric surgeons worldwide. In this study, we studied the outcome of children undergoing stoma closures without mechanical bowel preparation (MBP) in our department.
Materials and methods:
This is a retrospective observational study of children <18 years undergoing stoma closure from 2017 to 2021. The primary endpoints were surgical site infection (SSI), incisional hernia, anastomotic leak, and mortalities. The categorical data are expressed in percentages and the continuous data are in medians and interquartile ranges. The postoperative complications were classified according to the Clavien-Dindo system.
Results:
A total of 89 patients underwent stoma closure without bowel preparation during the study. The anastomosis leak and incisional hernia were seen in one patient each. The SSIs occurred in 23 patients (25.9%), which were superficial in 21 and deep in 2 patients. The Clavien-Dindo Grade III complications occurred in 2 (2.2%) patients. The median duration to start feeds and pass first stools was significantly longer in patients with ileostomy closure (P = 0.04 and 0.001, respectively).
Conclusion:
The outcome of stoma closures without MBP was favorable in our study and hence it can be suggested that the use of MBP in colostomy closures can be safely avoided in children.
... Several techniques have been used for ostomy closures since many years. Anorectal malformation was the most common cause of the colostomy in our study, which is consistent with the findings of Bischoff et al. 2 which showed mortality in ostomy closure 2 . ...
BACKGROUND
Type of ostomy closure has connection with some complications and also cosmetic effects.
AIMS
This study aimed to compare result of colostomy closure using purse-string method versus linear method in terms of surgical site infection, surgical time, and patient satisfaction.
METHODS
In this study, 50 patients who underwent purse-string ostomy closure and 50 patients who underwent linear closure were included. Two groups were compared for surgical time, wound infection, patient satisfaction, scar length. A p-value <0.05 was considered significant.
RESULTS
Wound infection was not reported among purse-string group compared to 10% in linear group (p=0.022). Scar length was 24.09±0.1 mm in purse string and 52.15±1.0 mm in linear group (p=0.033). Duration of hospital admission was significantly shorter in purse-string group (6.4±1.1 days) compared to linear (15.5±4.6 days, p=0.0001). The Patient and Observer Scar Assessment Scale scale for observer (p=0.038) and parents (p=0.045) was more favorable among purse-string group compared to linear.
CONCLUSION
Purse-string technique has the less frequent surgical site infection, shorter duration of hospital admission, less scar length, and more favorable cosmetic outcome, compared to linear technique.
HEADINGS:
Colostomy; Postoperative Complications; Infections; Infant, Newborn; Child
... It was proven to improve intraluminal and mucosal antibiotic concentration. 15,18 Bowel preparation was also able to prevent peritoneum contamination by eliminating contact between feces and anastomosis site. 19 Moreover, hard and solid feces can be prevented by this preparation as well. ...
... Instead, oral antibiotics were more likely to become the possible agents that eventually reduced the rates. 18 Those publications further encouraged surgeons to evaluate the practice of adult bowel preparation. ...
Background: Surgical procedure in colorectal cases have a high morbidity rate; in pediatric population, surgical site infection occurs in more than 13% of patients undergoing elective colorectal surgery. Bowel preparation is believed to decrease infection rate by removing feces from colorectal. This procedure has been routinely performed despite the lack of clear evidence and the invasive nature of the procedure. In pediatric population, the evidence is scarce with varying qualities, thus this study aims to evaluate the effect of bowel preparation on pediatric population. Methods: We conducted a comprehensive literature review from PubMed and cross-referencing articles. Six full-text studies presenting bowel preparation in pediatric colorectal surgeries were included in the analysis. Results: Majority of studies we analyzed showed no association between bowel preparation and surgical site infections. They also showed the lack of correlation between the procedure and post-operative complication. Discussion: Bowel preparation was quickly adapted by surgeons due to its theoretical effect, but current evidence showed no clear benefit in doing so. In pediatric cases, the evidence is scarce and variable, and with the risk associated, surgeons should consider carefully before conducting bowel preparation in pediatric patients. Conclusion: Bowel preparation does not significantly decrease post-operative morbidities, such as anastomosis leakage, intrabdominal infection, and surgical wound infection.
... Colostomy closure is a routine procedure in pediatric surgery practice, and it is done for indications, such as anorectal malformation, HSD, perianal injuries, complicated intussusceptions, complicated bowel atresia, and pelvic malignancies. 1 It has significant morbidity, and the total morbidity rate of stoma closure in pediatrics ranges from 15 to 55%. These morbidities include surgical site infections, anastomotic leaks, bleeding, anastomotic strictures, and even death. ...
... 5,6 Pena reported a much lower rate of morbidity, 1.5%, in a retrospective study of 628 patients over 28 years. 1 The complications noted in the literature and also in our study were SSI, incisional hernia, adhesive intestinal obstruction, and anemia. Our study had included hospital-acquired pneumonia as a postoperative complication, but it had not been mentioned in other studies. ...
... Some studies mentioned technical factors as a cause of the incisional hernia, and Mullassery found age below six months and wound infection to be risk factors for incisional hernia, but in our study, no association was found. 1,17 There was no anastomotic leak or deep space collection in this study, but the anastomotic leak rate in other studies varies from 1% to 5.7%. Only a few series reported had no anastomotic leak or fistula. ...
Background: Colostomy Closure is a routine procedure in pediatric surgery services. It is usually done for indications such as anorectal malformation, Hirschsprung's disease, and trauma. It is associated with significant complications. Purpose: To assess the effect of perioperative factors on colostomy closure outcome in children. Methods: This is a prospective observational study on all children who underwent colostomy closure at Tikur Anbessa Specialized Hospital and Menelik II Referral Hospital from January 2019-February 2020, and Demographic data, nutritional status of the child, duration of mechanical bowel preparation, prophylactic antibiotic, type of anastomosis, operative details, and other perioperative factors were recorded, and patients were followed postoperatively for any complications. Data were entered and analyzed using SPSS 23, and perioperative factors were analyzed using χ 2 tests for association with outcome. A p value of <0.05 was considered statistically significant. Results: A total of 71 patients were included in the study, and forty-two (59%) were female, and the median age was 2.3 years. A total of 23 complications occurred in 13 (18.3%) patients, and surgical site infection (SSI) was the most common complication occurring in 8 (11.3%) patients. Four (5.6%) patients had anemia which required transfusion, and complete wound dehiscence and adhesive intestinal obstruction each occurred in 1 (1.4%) patient. Duration of surgery >120 min was associated with an increased risk for postoperative need for transfusion; otherwise, there was no association between other perioperative factors and other complications. Conclusion: In this study, except for the duration of surgery, none of the other perioperative factors are associated with the complications of colostomy closure, so a guideline for optimal and uniform perioperative care of children undergoing colostomy closure should be prepared.
... The temporary stoma is a common procedure that is performed in children with gastro-intestinal problems (e.g., anorectal malformation, spontaneous intestinal perforation, necrotizing enterocolitis, and Hirschsprung's disease). Surgical site infections (SSI) are one of the most common complications following stoma reversal, and the incidences can be up to 40% [1][2][3][4][5][6]. This confers morbidity on individual patients and can lead to prolonged hospital stays. ...
... Surgical site infections (SSI) are one of the most common complications following stoma reversal operations and have been reported in the range of 0-40% [1][2][3][4][5][6]. Several procedures have been studied to reduce this problem, which have included mechanical bowel preparation, pre-operative antibiotics, skin preparation, peri-operative bundles, perioperative temperature, and surgical techniques [6,8,[13][14][15][16][17]. In our study, 17 (22.4%) of the 76 patients, who had undergone stoma reversal, developed SSI. ...
... Surgical site infections (SSI) are one of the most common complications following stoma reversal operations and have been reported in the range of 0-40% [1][2][3][4][5][6]. Several procedures have been studied to reduce this problem, which have included mechanical bowel preparation, pre-operative antibiotics, skin preparation, peri-operative bundles, perioperative temperature, and surgical techniques [6,8,[13][14][15][16][17]. In our study, 17 (22.4%) of the 76 patients, who had undergone stoma reversal, developed SSI. ...
Background
To reduce the surgical site infections (SSI), the purse-string closure technique has been widely performed and has also been recommended in adult stoma reversal. However, for children, some debate still exists. This study aims to compare the SSI rates in children between the purse-string and the linear for the skin closure of stoma reversal.Methods
The data were collected from pediatric patients, who had undergone either purse-string or linear closure for elective surgery of stoma reversal from two university hospitals between January 2016 and December 2019.ResultsThe purse-string and linear closure had been performed on 31 and 45 patients, respectively. At 30 days after surgery, three patients in the purse-string closure group had developed SSI compared to 14 patients in the linear closure group (9.7 vs. 31.1%, p = 0.028). Furthermore, there had been no significant difference in the overall post-operative complications. In multivariate analysis, the SSI had been significantly lower in patients with purse-string closure (OR 0.21, 95% CI 0.05–0.86, p = 0.029).Conclusion
By employing the purse-string closure technique for skin closure of stoma reversal, there had been a significantly lower SSI rate compared to linear closure with no difference in the length of hospital stay.
... Typically, this window is created 5 to 10 cm proximal to the anastomosis. For size discrepancies up to 4:1 an endto-end anastomosis is preferred and in size discrepancies greater than 4:1 but smaller than 10:1 a side-to-end anastomosis is preferred, but both without a window-type of stoma proximal of the anastomosis [10]. ...
Objectives: To report a case of a stoma reversal in a patient with an acquired, extreme microcolon after a long-standing transversostomy and to give a review of the current literature. Methods: Case report and literature review by performing a PubMed database search, using the keywords Santulli enterostomy, anal atresia, posterior sagittal anorectoplasty and acquired microcolon. Results: An 18-year-old patient with a previous history of anal, rectal and sigmoid atresia, was admitted to our hospital with an acquired microcolon due to a long-standing transversostomy. The patient had a posterior sagittal anorectoplasty at the age of one year, but by reason of an enormous dilatation of the ascending colon and the associated discrepancy of the caliber of the proximal and distal colon, the colostomy was maintained. The patient was lost in follow-up during several years. Now, 16 years later, the patient requested closure of the colostomy. Since barium enemas still showed a dilated colon ascendens and a microcolon descendens, a staged approach was chosen. First, a right hemicolectomy was performed and a Santulli enterostomy was created by constructing an ileocolostomy just proximal of an end ileostomy. Progressively, more transanal bowel movements were seen and barium enemas showed a progressive expansion of the remaining colon and rectum. Test closing of the enterostomy using an inflated bladder catheter did not cause signs of obstruction. During the second stage, 17 months later, at the age of 20 years, the stoma was closed. Now, the patient has two to three solid stools a day, with a complete fecal continence. Discussion: The used technique is well known in pediatric surgery. We successfully implemented it in the treatment of a microcolon in an adult. The advantage is that we can feed the distal colon to achieve expansion, while the enterostomy functions as a venting system, hereby preventing obstructive complaints when the caliber of the colon is still narrow. In conclusion, long-standing colostomas with a concurrent microcolon can be closed but require a step-by-step approach.
... Anorectal malformations (ARM) affect 1 in 5000 children [1], with approximately 50% requiring the creation of a sigmoid or descending colostomy before definitive surgical reconstruction. While a colostomy is safe and often necessary, the rate of complications ranges from 28to 74% [1,2]; problems with prolapse, anastomotic breakdown, strictures, and intestinal obstruction can occur and often require reoperation [1][2][3][4]. In children with ARM who are struggling with fecal soiling or antegrade enema access issues, the performance of a contrast enema or antegrade contrast study can identify if the previous colostomy or closure site is contributing to the current problem [5,6]. ...
... While the creation of a colostomy is necessary for initial fecal diversion in a majority of patients, they are not without risk of complications [1][2][3][4]. In one study of patients with intermediate or high ARMs, 32% had mechanical complications, including 7 patients who developed intestinal obstruction [1]. ...
Introduction:
Anorectal malformations (ARM) are complex disorders that often require staged reconstructions. We present a case and imaging findings of a child who developed issues following colostomy closure due to segmental colonic ischemia. Case Presentation. A 3-year-old female with Currarino syndrome presented with abdominal distention, blood-flecked stools, and prolonged cecostomy flush time. For her anorectal malformation, a colostomy was initially placed. A new colostomy was created at posterior sagittal anorectoplasty (PSARP) to allow the distal rectum to reach the anus without tension. Differentials for her presenting symptoms included a mislocation of the anus, stenosis at the anoplasty site, stricture within the colon, or sacral mass from Currarino syndrome, causing obstructive symptoms. Workup at our hospital included an anorectal exam under anesthesia (EUA), which showed a well-located anus with without stenosis at the anoplasty site, and an antegrade contrast study revealed a featureless descending colon with a 3-4 mm stricture in the distal transverse colon at the site of the previous colostomy, without an obstructing presacral mass. To alleviate this obstruction, the child underwent removal of the chronically ischemic descending colon and a redo-PSARP, where the distal transverse colon was brought down to the anus. She is now able to successfully perform antegrade flushes.
Conclusion:
Patients who have had prior surgeries for ARM repair are at a higher risk of complications, including strictures or ischemic complications at areas of previous surgery or colostomy placement. A thorough preoperative workup, including contrast studies, can alert the surgeon to these potential pitfalls.
... 7 The complications of colostomy include obstruction, leak, stricture and incisional hernia in as much as 1.5%-55% patients. [8][9][10] The burden of stoma care, repeated admission for dehydration, and subsequent psychosocial burden to the family should not be underestimated. Repeated surgery and multiple scars also lead to personality disorders. ...
Introduction:
One-stage anorectoplasty provides maximum potential for "normal" defecation reflexes right at birth and avoids complications and problems of colostomy. One-stage laparoscopic anorectoplasty (OSLARP) for rectourinary fistula (RUF) is restricted by distended bowel obscuring the working space for laparoscopy. This study describes transperineal intracath meconiolysis and evacuation (TIME) technique for OSLARP in the treatment of RUF in neonates.
Materials and Technique:
High male anorectal malformation (ARM) admitted from January 2016 to March 2019 were included in the study. Diagnosis of level of ARM was made on the basis of invertogram. Patient presenting with lethal comorbidities were excluded who underwent colostomy. The technique involved placement of a 16G intracath in the perineum through the site of future neo-anus, which was identified using muscle stimulator. Meconiolysis and evacuation was done using warm saline and 2% N-acetyl. The creation of enough abdominal space was achieved after evacuation and two working instruments were placed in paraumbilical positions. The laparoscopic dissection and division of fistula was done as followed in standard laparoscopic anorectoplasty.
Results:
Seventeen patients were selected for TIME technique but on laparoscopy 2 patients had severe necrotizing enterocolitis hence they underwent laparoscopy-assisted high sigmoid colostomy. Fifteen patients underwent OSLARP successfully. Mean weight was 2.5 ± 0.4 kg, mean gestational age was 36 ± 5 weeks, and mean age of presentation was 3.5 ± 1 days after birth. The TIME technique was successful decompressing bowel in all the patients. Out of 15 patients of OSLARP, 14 had rectoprostatic urethral fistula and 1 had rectovesical fistula. Mean total operative duration of OSLARP was 46 ± 15 minutes. Patients who could be followed for 3 years had good results in terms of continence and bowel movements.
Discussion:
TIME technique is a very simple and effective way to overcome the problem of associated colonic distention in neonatal one-stage laparoscopic anoplasty.
... 1,2 The optimal timing and method of reversal depend on a number of clinical factors, among which are the nature of the disease for which the ostomy was indicated, patient comorbidities, hemodynamic and respiratory stability, nutritional status, feeding tolerance, age, and weight. 3 Whereas risk factors for complications after ostomy reversal in adults are well described, factors contributing to poor outcomes after ostomy reversal in infants are not well characterized. [4][5][6] The purpose of our study was to identify risk factors for 30-day complications after ostomy reversal in infants less than six months old. ...
... One series of 649 children who underwent colostomy closure by a single surgeon reported a complication rate of only 1.5 per cent. 3 Another series of 54 preterm infants who underwent enterostomy reversal at a single institution reported a complication rate of 65 per cent. 1 Findings of our study lie between these extremes and are comparable with the complication rates reported in other studies. [11][12][13] The most frequent complication in our study was SSI, with an incidence of 5.7 per cent, which is RRs were calculated from ORs. 10 ORs were derived using multivariate logistic regression, with independent variables selected based on association with 30-day complication on univariate analysis. ...
The purpose of this study was to determine risk factors for 30-day complications, reoperation, and readmission after ostomy reversal in infants less than six months old. Infants aged two weeks to six months who underwent ostomy reversal were identified in the 2012 to 2016 ACS NSQIP Pediatric database. Demographics, comorbidities, and 30-day outcomes were assessed. Multivariable logistic regression was used to estimate the independent effects of clinical variables on risk of 30-day complications, reoperation, and readmission. Among 1021 infants, 163 (16%) suffered a 30-day complication. SSIs were the most common complication (5.7%), followed by unplanned reintubation (5.2%) and bleeding (3%). Mortality was 0.4 per cent. Dependence on nutritional support and hematologic disorders were independently associated with postoperative complications. Forty-five children (4.4%) required reoperation and 22 (2.2%) were readmitted for conditions related to the procedure. Younger age and preoperative dependence on oxygen or nutritional support were associated with increased length of stay. SSI, unplanned reintubation, and bleeding are the most frequent complications after ostomy takedown in infants less than six months old. Attention to risk factors predisposing to these complications, including dependence on nutritional support and hematologic disorders, may contribute to improved surgical outcomes.
