Use of T-Tube Enterostomy in Neonatal Gastro-intestinal Surgery

Abstract

Aim: To evaluate the results of the use of the T-tube ileostomy in neonatal intestinal surgery cases. Materials and Methods: A retrospective review of sixty two neonates underwent intestinal obstruction surgery by using T-tube ileostomy was conducted between January 1990 and January 2013.The pathologies of the intestinal obstruction were; thirty four of jejunoileal atresia cases, thirteen case meconium ileus, eight cases perforated necrotizing enterocolitis (NEC), three cases meconium peritonitis, three cases with bowel resection due to intestinal volvulus, and one case of gastroschisis. Results: Mean duration of T-tube placement was 13 days (range9–20days) and the sites of T-tube insertion closed spontaneously in 2 days (range 1-4 days). The mean duration for starting oral intake postoperatively in these patients was 9 days (6-16 days). All patients well tolerated the procedure and there were no serious complications related to the T-tube insertion. However, four patients died due to other reasons like sepsis, respiratory failure and prematurity. Conclusion: T-tube enterostomy is an effective and safe technique for treatment of selected cases of neonatal intestinal surgery. It showed less morbidity and mortality rates than the conventional stoma. Therefore, it is considered a helpful approach in cases where there is danger of hypoperistaltic dilated bowel proximal to the anastomosis.

T-tube enterostomy in the management of apple-peel atresia: A case series from a single center

“…Two case reports were published describing the use of Foley’s catheter and T-tube, using transanastomotic feeding tubes in both cases ( 9 , 14 ). Al-Zaiem et al performed a retrospective study on the use of a T-tube in neonatal gastrointestinal surgery over 62 neonates including 34 jejunoileal atresias; however, no specifications on the number of apple-peel cases encountered in his study ( 15 ).…”

T-tube enterostomy in neonates with perforated necrotizing enterocolitis as an alternative option

“…Also, it remained advantageous as for evaluation of the bowel continuity in the distal part, by injecting contrast material through the T-tube. 16 The mechanism of insertion in those cases is similar to the usual way described elsewhere but only the suitable size and choosing an apparently healthy loop of intestine proximal to the first anastomosis without extending it to cross the anastomotic line to avoid the pressure effect on it due to edema. 17 Rygl and his colleagues who use the tube in extremely low birth weight neonates with isolates intestinal perforation but in this study, we emphasize that it can be used in cases have more extensive ischemia which need even more than on anastomosis with good results.…”

“…Just to keep the tube opened which is helpful in keep its role in decompressing the bowel and protecting the anastomosis. 16 The number of patients is limited in this study because of, perforated NEC patient is mostly unstable and either not candidate for surgical intervention, or there are no experts in giving anesthesia to those particular very low birth weight, highly risk and unstable patients. Also, in many pediatric surgery centers, T tube is not available in operative rooms as routinely.…”

Medical Care of Newborns With Meconium Ileus. Data Analysis of World Experience and Own Observations

“…Через пряму кишку у ліві відділи товстої кишки, що регіструється на рентгеновському екрані або на екрані апарату УЗД. При цьому гастрографін омиває велику меконієву пробку, що починає фрагментуватися, поступово просуватися у дистальні відділи товстої кишки і виходити зовні [55,56]. Промивання і випорожнення кишечника має проводитись під контролем екрану, з обережним і повільним збільшенням внутрішньопросвітного тиску.…”