Determining the Timing for the Enterostomy Repair using Age-based Analysis

Min Jung Kang; Juyoung Lee; Han-Suk Kim; Jae-Sung Ko; Kwi-Won Park

doi:10.14734/kjp.2013.24.4.251

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Kang, Lee, Kim, Ko, and Park: Determining the Timing for the Enterostomy Repair using Age-based Analysis

Original Article

Korean J Perinatol 2013;24(4):251-258.

Published online: 19 January 2013

DOI: https://doi.org/10.14734/kjp.2013.24.4.251

Determining the Timing for the Enterostomy Repair using Age-based Analysis

Min Jung Kang¹, Juyoung Lee, M.D.², Han-Suk Kim, M.D.^2,, Jae-Sung Ko, M.D.², Kwi-Won Park, M.D.³

¹Department of Medical Science, Seoul, Korea

²Department of Pediatrics, Department of Pediatric Surgery, Seoul, Korea

³Department of Seoul National University College of Medicine, Seoul, Korea

주관책임자 : 김한석, 110 -799, 서울 특별시 종로구 대학로 103 서울대학교 의과대학 소아과학교실 전화 : 02)2072-1696, 전송 : 02)743-3455/02)747-5130 E-mail : kimhans@snu.ac.kr

Received 22 August 2013 Revised 25 October 2013 Accepted 1 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose :

The purpose of this study was to determine if timing of enterostomy repair described in terms of postmenstrual age (PMA) could influence postoperative course, complications, and growth.

Methods :

Under the Institutional Review Board approval, records of preterm infants who underwent enterostomy and subsequent repair from 2007 to 2013 at Seoul national university children's hospital were reviewed. Records of infants with congenital anomalies were excluded. Data collected included baseline characteristics, PMA, weight at enterostomy and enterostomy repair, postoperative course, enterostomy repair-related complications, and follow-up growth after repair. For analysis, patients were divided into 2 groups: group 1 with enterostomy repaired before PMA 40 weeks; and group 2 with enterostomy repaired since PMA 40 weeks.

Results :

There were 54 infants: 16 in group 1 and 38 in group 2. The median weight at the time of enterostomy repair was greater in group 2 compared to those of group 1. Group 1 infants had more complications and had to be ventilated longer after enterostomy repair. They required longer periods of total parenteral nutrition and took longer to reach full enteral feeding. Group 1 infants also needed longer hospital stay after enterostomy repair. No statistical difference was observed in growth after discharge.

Conclusion :

The timing of enterostomy repair influences postoperative course and complications significantly. Therefore, it is recommended that enterostomy repair should be withheld until PMA 40 weeks. For predicting long term prognosis, more studies will be required.

Keywords: Enterostomy, Enterostomy repair, Premature infant

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Fig. 1

Flow diagram showing the study design involving the 88 infants enrolled in this study.

Table 1.

Comparison of Baseline Characteristics between Two Groups

	Group 1 (n=16)	Group 2 (n=38)	P value
Gestational age, weeks	27⁺¹ (23⁺⁵-30⁺²)	25⁺⁶ (23⁺¹-35⁺⁵)	0.747
Birth weight, g	720 (663-978)	790 (655-1,249)	0.302
Gender (male : female), %	75:25	74:26	1.000
Apgar score 1	3 (1-7)	3 (0-7)	0.462
Apgar score 5	7 (4-9)	5 (0-9)	0.039
Small for gestational age	5 (31%)	11 (29%)	1.000
Oligohydramnios	2 (13%)	6 (17%)	1.000
RDS	11 (69%)	28 (74%)	0.747
BPD	13 (81%)	30 (79%)	1.000
IVH, higher than grade 2	3 (19%)	17 (45%)	0.122
Mechanical ventilation days, birth to E	7 (2-28)	9 (1-33)	0.798
TPN days, birth to E	9 (2-40)	10 (1-33)	0.648

Abbreviations : RDS, respiratory distress syndrome; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; E enterostomy; TPN, total parenteral nutrition Values are expressed as median and ranges in parentheses or numbers of individuals with percentages in parentheses (%)

Table 2.

Comparison Related to Enterostomy between Two Groups

	Group 1 (n=16)	Group 2 (n=38)	P value
Postmenstrual age at E, weeks	27⁺⁵ (25⁺¹-33⁺³)	28⁺¹ (25⁺¹-42⁺⁰)	0.324
Weight at E, g	765 (615-955)	835 (658-1,433)	0.153
Weight gain from E to ER, g/week	121 (59-191)	131 (0-257)	0.663
Cause (NEC : SIP : MPS), %	62:19:19	58:18:24	0.921
High output stoma	5 (31%)	18 (47%)	0.370
E-related complications	9 (56%)	17 (45%)	0.439
Reoperation after E	6 (38%)	14 (37%)	0.964
Mechanical ventilation days, E to ER	19 (2-84)	23 (1-97)	0.727
TPN days, E to ER	22 (9-70)	29 (11-72)	0.161
Time interval between E and ER, weeks	9⁺⁶ (2⁺⁵-14⁺⁴)	15⁺⁶ (4⁺⁶-52⁺⁰)	<0.001

Abbreviations : E, enterostomy; ER, enterostomy repair; NEC, necrotizing enterocolitis; SIP, spontaneous intestinal perforation; MPS, meconium plug syndrome; TPN, total parenteral nutrition Values are expressed as median and ranges in parentheses or numbers of individuals with percentages in parentheses (%)

Table 3.

Comparison Related to Enterostomy Repair between Two Groups

	Group 1 (n=16)	Group 2 (n=38)	P value
Postmenstrual age at ER, weeks	38⁺¹ (34⁺²-39⁺⁵)	45⁺² (40⁺¹-80⁺⁰)	<0.001
Weight at ER, g	1,885 (1,735-2,290)	3,130 (2,308-4,283)	<0.001
ER-related complications	15 (94%)	21 (55%)	0.010
Vasopressor use after ER	5 (31%)	5 (13%)	0.141
Mechanical ventilation days after ER	3.5 (0-137)	0 (0-15)	0.004
TPN days after ER	10 (6-91)	7 (3-27)	0.015
Days to reach full enteral feeding	11 (7-47)	9 (5-28)	0.017
Hospital stay after ER, days	24 (11-345)	12 (5-136)	0.005
Reoperation after ER	2 (13%)	7 (18%)	0.709
Death after ER	0 (0%)	1 (3%)	1.000

Abbreviations : ER, enterostomy repair; TPN, total parenteral nutrition Values are expressed as median and ranges in parentheses or numbers of individuals with percentage s in parentheses (%)

Table 4.

Complication Related to Enterostomy Repair

Complication	Group 1 (n=16)	Group 2 (n=38)	Pvalue
Wound oozing	8 (50.0)	12 (31.6)	0.201
Wound redness or bulging	10 (62.5)	9 (23.7)	0.006
Paralytic ileus	7 (43.8)	6 (15.8)	0.028
Wound infection	5 (31.3)	4 (10.5)	0.106
Wound dehiscence	3 (18.8)	4 (10.5)	0.410
Adhesional obstruction	3 (18.8)	4 (10.5)	0.410
Incisional hernia	1 (6.3)	4 (10.5)	1.000
Pneumonia	1 (6.3)	3 (7.9)	1.000
Sepsis	2 (12.5)	2 (5.3)	0.573
Intestinal perforation	0 (0.0)	1 (2.6)	1.000
Anastomotic site disruption	0 (0.0)	1 (2.6)	1.000
Anastomotic site leakage	0 (0.0)	1 (2.6)	1.000
Intestinal obstruction	0 (0.0)	1 (2.6)	1.000
Enterocutaneous fistula	1 (6.3)	0 (0.0)	0.296
Skin necrosis	0 (0.0)	1 (2.6)	1.000

Values are expressed as numbers of individuals

Table 5.

Follow Up Growth Comparison of the Two Groups

	Group 1 (n=16)	Group 2 (n=38)	Pvalue
Weight at CA 7 months, kg	6.6 ± 1.1	6.5 ± 1.7	0.901
Height at CA 7 months, cm	64.3 ± 3.9	64.7 ± 3.0	0.735
Weight at CA 10 months, kg	7.4 ± 0.8	7.9 ± 1.2	0.335
Height at CA 10 months, cm	66.2 ± 4.5	70.1 ± 3.0	0.130
Weight at CA 15 months, kg	8.3 ± 0.5	9.0 ± 1.2	0.327
Height at CA 15 months, cm	72.1 ± 1.3	77.0 ± 2.7	0.089

Abbreviations : CA, corrected age Values are expressed as mean ± standard deviation

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