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Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation.

Publication ,  Journal Article
Talbot, LJ; Sinyard, RD; Rialon, KL; Englum, BR; Tracy, ET; Rice, HE; Adibe, OO
Published in: J Pediatr Surg
January 2017

PURPOSE: Neonates after emergent enterostomy creation frequently require reversal at low weight because of complications including cholestasis, dehydration, dumping, failure to thrive, and failure to achieve enteral independence. We investigated whether stoma reversal at low weight (< 2.5kg) is associated with poor surgical outcomes. METHODS: Patients who underwent enterostomy reversal from 2005 to 2013 at less than 6months old were identified in our institutional database. Only patients who underwent emergent enterostomy creation (i.e. for necrotizing enterocolitis or spontaneous perforation) were included. Demographics, disease process, comorbidities, stoma type, reversal indication, operative details, and complications were examined. Patients were categorized by weight at reversal of less than 2kg, 2.01-2.5kg, 2.51-3.5kg, and greater than 3.5kg. Data were analyzed using univariable and multivariable regression with significance level of p<0.05. The primary outcome examined was major morbidity, defined as the presence of anastomotic leak, obstruction, hernia, EC fistula, perforation, wound infection, sepsis, or death. RESULTS: Eighty-nine patients met inclusion criteria. Demographics (sex, ethnicity, surgical disease process, reversal indication, and ASA score) were similar. The lowest weight group had lower gestational age (p<0.001) and birth weight (p=0.005), and contained a higher proportion of jejunostomies to ileostomies (p=0.013). On univariable analysis, only incisional hernia was significantly different as a complication between weight groups. On multivariable analysis controlling for gestational age and ASA, there was no significant difference in odds of major operative morbidity between groups. CONCLUSIONS: Enterostomy reversal at lower weight may not be associated with increased risk of perioperative complications. Early stoma reversal may be acceptable when required for progression of neonatal care. LEVEL OF EVIDENCE: Level III, Treatment Study (Retrospective comparative study).

Duke Scholars

Published In

J Pediatr Surg

DOI

EISSN

1531-5037

Publication Date

January 2017

Volume

52

Issue

1

Start / End Page

35 / 39

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgical Stomas
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Pediatrics
  • Male
  • Intestinal Perforation
  • Infant, Newborn
  • Infant
 

Citation

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Talbot, L. J., Sinyard, R. D., Rialon, K. L., Englum, B. R., Tracy, E. T., Rice, H. E., & Adibe, O. O. (2017). Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation. J Pediatr Surg, 52(1), 35–39. https://doi.org/10.1016/j.jpedsurg.2016.10.015
Talbot, Lindsay J., Robert D. Sinyard, Kristy L. Rialon, Brian R. Englum, Elizabeth T. Tracy, Henry E. Rice, and Obinna O. Adibe. “Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation.J Pediatr Surg 52, no. 1 (January 2017): 35–39. https://doi.org/10.1016/j.jpedsurg.2016.10.015.
Talbot LJ, Sinyard RD, Rialon KL, Englum BR, Tracy ET, Rice HE, et al. Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation. J Pediatr Surg. 2017 Jan;52(1):35–9.
Talbot, Lindsay J., et al. “Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation.J Pediatr Surg, vol. 52, no. 1, Jan. 2017, pp. 35–39. Pubmed, doi:10.1016/j.jpedsurg.2016.10.015.
Talbot LJ, Sinyard RD, Rialon KL, Englum BR, Tracy ET, Rice HE, Adibe OO. Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation. J Pediatr Surg. 2017 Jan;52(1):35–39.
Journal cover image

Published In

J Pediatr Surg

DOI

EISSN

1531-5037

Publication Date

January 2017

Volume

52

Issue

1

Start / End Page

35 / 39

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgical Stomas
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Pediatrics
  • Male
  • Intestinal Perforation
  • Infant, Newborn
  • Infant