PubMed · 7933892
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1994. [Stapling techniques - general surgery].. https://pubmed.ncbi.nlm.nih.gov/7933892/
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OBJECTIVES: To examine the morbidity and mortality in 109 newborns who required enterostomy for intestinal necrosis, perforation, or obstruction and to analyze the complications associated with enterostomy closure. DESIGN: Data were collected retrospectively from hospital and office charts. Follow-up was 1 to 6 years. SETTING: Tertiary care, newborn intensive care unit at a children's hospital. PATIENTS: A referred sample of 109 newborns (aged 0 to 28 days) with bowel necrosis, obstruction, or perforation, who underwent enterostomy as part of their therapy. INTERVENTIONS: Operative formation of any enterostomy during laparotomy for bowel necrosis, obstruction, or perforation and subsequent closure. MAIN OUTCOME MEASURES: Morbidity and mortality associated with newborn enterostomy and its closure. RESULTS: Patients underwent jejunostomy (n = 31), ileostomy (n = 62), or colostomy (n = 16) for necrotizing enterocolitis (n = 79), atresia (n = 15), idiopathic perforation (n = 8), volvulus (n = 4), or meconium ileus (n = 3). Seventeen (16%) died postoperatively of sepsis, respiratory distress, further necrotizing enterocolitis, or intraventricular hemorrhage. Complications developed in 10 (34%) of the remaining 29 patients who underwent jejunostomy, whereas in 13 (26%) of 50 patients who underwent ileostomy and three (23%) of 13 patients who underwent colostomy, complications requiring revision developed. Ninety-two patients underwent enterostomy closure 14 to 65 days after enterostomy. Four later died of continuing respiratory distress and liver failure. Fifteen (56%) of 27 jejunostomies, 28 (57%) of 49 ileostomies, and nine (75%) of 12 colostomies were closed uneventfully, whereas two jejunostomy and eight ileostomy closures dehisced, requiring repeated enterostomy and secondary closure. All 10 children with anastomotic dehiscence had necrotizing enterocolitis originally, showed poor weight gain (< 30% per month), and had low serum albumin levels (22 +/- 3 g/L) compared with children with successful primary closure (> 30% weight gain per month; serum albumin level, 37 +/- 6 g/L; both Ps < .05). CONCLUSION: These data show that enterostomy is a potentially morbid condition in the newborn and is prone to complications but should be closed only when the child is in satisfactory nutritional condition.
An easier method in constructing a J-pouch is described using an endoscopic stapler. Although not designed for open procedures, the length of this instrument allows the J-loop to slide up the device following each staple application. Close opposition of the antimesenteric borders of the ileum is thus more easily achieved, telescoping of the bowel is avoided, and the enterostomy does not become unnecessarily enlarged.
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