A Multi-Institutional Study Comparing Stoma Location in Neonates With Intestinal Perforation

Stephanie Y Chen; Gabriella Grisotti; Shale J Mack; Ashley E Walther; Rachel L Chapman; Richard A Falcone Jr; Eugene S Kim

doi:10.1016/j.jss.2024.01.031

A Multi-Institutional Study Comparing Stoma Location in Neonates With Intestinal Perforation

J Surg Res. 2024 May:297:56-62. doi: 10.1016/j.jss.2024.01.031. Epub 2024 Mar 2.

Authors

Stephanie Y Chen¹, Gabriella Grisotti², Shale J Mack³, Ashley E Walther⁴, Rachel L Chapman⁵, Richard A Falcone Jr², Eugene S Kim⁶

Affiliations

¹ Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
² Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
³ Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
⁴ Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁵ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, California; Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
⁶ Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: Eugene.kimx@cshs.org.

PMID: 38432084
DOI: 10.1016/j.jss.2024.01.031

Abstract

Introduction: Neonates with intestinal perforation often require laparotomy and intestinal stoma creation, with the stoma placed in either the laparotomy incision or a separate site. We aimed to investigate if stoma location is associated with risk of postoperative wound complications.

Methods: A multi-institutional retrospective review was performed for neonates ≤3 mo who underwent emergent laparotomy and intestinal stoma creation for intestinal perforation between January 1, 2009 and April 1, 2021. Patients were stratified by stoma location (laparotomy incision versus separate site). Outcomes included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression identified factors associated with postoperative wound complications, controlling for gestational age, age and weight at surgery, and diagnosis.

Results: Overall, 79 neonates of median gestational age 28.8 wk (interquartile range [IQR]: 26.0-34.2 wk), median age 5 d (IQR: 2-11 d) and median weight 1.4 kg (IQR: 0.9-2.42 kg) had perforated bowel from necrotizing enterocolitis (40.5%), focal intestinal perforation (31.6%), or other etiologies (27.8%). Stomas were placed in the laparotomy incision for 41 (51.9%) patients and separate sites in 38 (48.1%) patients. Wound infection/dehiscence occurred in 7 (17.1%) neonates with laparotomy stomas and 5 (13.2%) neonates with separate site stomas (P = 0.63). There were no significant differences in peristomal irritation, stoma retraction, or stoma stricture between the two groups. On multivariable regression, separate site stomas were associated with increased likelihood of prolapse (odds ratio 6.54; 95% confidence interval: 1.14-37.5).

Conclusions: Stoma incorporation within the laparotomy incision is not associated with wound complications. Separate site stomas may be associated with prolapse. Patient factors should be considered when planning stoma location in neonates undergoing surgery for intestinal perforation.

Keywords: Intestinal perforation; Laparotomy; Neonate; Ostomy; Pediatric surgery; Wound infection.

Publication types

Multicenter Study

MeSH terms

Adult
Child, Preschool
Constriction, Pathologic
Humans
Infant, Newborn
Intestinal Perforation* / surgery
Postoperative Complications
Prolapse
Retrospective Studies
Surgical Stomas*
Surgical Wound*
Wound Infection*