Ostomy Closures in Children: Variations in Perioperative Care Do Not Change the Outcome

Abstract

This study aimed to evaluate ostomy closure applications and outcomes and determine the effect of personal differences among surgeons on patient postoperative course. Ninety-eight patients who underwent elective ostomy (ileostomy and colostomy) closure for 8 years at a pediatric surgery training department were investigated. Postoperative complications included superficial surgical site infection (SSI; 9.4 %), organ/cavity infection (1 %), small bowel adhesions (8.2 %), and incisional hernia (1 %). SSI and postoperative complications were not affected by the preoperative antibiotic regimen used. Operation duration, pre-and postoperative antibiotic use durations, postoperative inpatient period, ostomy type, primary diagnosis, performance of abdominal exploration, SSI, and postoperative complications were not significantly different. However, the time of nasogastric (NG) tube withdrawal, time to oral feeding initiation, abdominal closure method used, and preoperative antibiotic regimen were significantly different among different surgeons. We conclude that while surgeons used different preoperative antibiotic regimens and abdominal closure methods and stipulated different times for NG tube withdrawal and oral feeding initiation, the postoperative course and prognosis were unaffected Thus, the preand postoperative inpatient period and antibiotic use duration can be decreased in children by procedure standardization using practice guidelines; the procedures can also be performed with a more aesthetic, acceptable incision.

Retrospective analysis of the outcome of stoma closure in children without preoperative mechanical bowel preparation

“…[ 6 11 15 16 ] The median operating time for surgery was 120 min which was comparable to the time mentioned in other studies. [ 4 17 ]…”

“…Many surgeons use NGT considering it to be helpful in the early resumption of bowel function, prevention of anastomotic leaks, and prevention of aspiration. [ 4 ] We inserted NGT in the postoperative period, only when there was abdominal distension or vomiting, and only 35% of patients required postoperative NGT insertion in our cohort of colostomy closures. The time taken to pass first stools and start feeds was significantly shorter in the patients with colostomy closure as compared to ileostomy closure.…”

“…Furthermore, the durations to remove NGT and start oral feeds were shorter while the time taken to pass the first stool was comparable to those studies where the NGT was routinely inserted and MBP was performed. [ 4 7 17 ] In the comparison of the MBP group with no MBP group, Leys et al . and Aldrink et al .…”

“…The median LOS was 7 days which was also comparable to those mentioned in the literature. [ 4 6 15 16 17 18 ]…”

“…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. [ 4 ]…”