Journal List > J Korean Assoc Pediatr Surg > v.24(1) > 1098226

Ihn, Koo, Ho, Han, and Oh: Santulli Enterostomy: A Considerable Method for Patients Who Require Proximal Enterostomy

Abstract

Purpose

Santulli enterostomy has been used for various surgical abdominal conditions that require temporary diversion of bowel during a neonatal period. The aim of this study was to report clinical outcomes of Santulli enterostomy and to evaluate its usefulness.

Methods

Between January 2000 and December 2016, 40 neonates who underwent Santulli enterostomy were enrolled; Santulli enterostomies were performed for 25 patients without previous laparotomy (primary Santulli group) and 15 patients with previous laparotomy (secondary Santulli group).

Results

Small bowel atresia is the first common indication of Santulli enterostomy (22/40, 55.0%), and luminal discrepancy between proximal and distal bowel was the most common determinant factor of Santulli enterostomy (17/40, 42.5%). The median age at surgery and mean birth weight were 2 days and 2,480 g respectively in the primary group, and 71 days, 2,340 g respectively in the secondary group. Operation time was significantly longer in the secondary group than the primary group (156±48 minutes vs. 224±95 minutes, p=0.019), and there was no difference in the time taken to initiation of oral feeding between the two groups. Santulli enterostomy closure was performed at median 65 days after Santulli enterostomy for primary group and 70 days for secondary group. Six complications (15.0%) were found after Santulli enterostomy, and nine complications (24.3%) after Santulli enterostomy closure (p=0.302). The incidence of complications was significantly higher in secondary group than in primary group (4.5% vs. 53.3%, p=0.001), and the reoperation rate was also significantly higher in the secondary group (4.5% vs. 46.7%, p=0.004).

Conclusion

Santulli enterostomy could be applied as a temporary enterostomy in neonatal patients with various surgical abdominal diseases. Considering the high complication rate after secondary Santulli enterostomy closure, decision making on the timing of enterostomy closure should be done with caution.

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Fig. 1.
Flowchart showing the study design including 40 patients enrolled in this study.
jkaps-2018-24-1-20f1.tif
Table 1.
Demographic Data and Diseases Requiring Santulli Enterostomy
Variable Value (n=40)
Sex (male/female) 21/19
Gestational age (wk) 37 (24.3-40.9)
Birth weight (g) 2,430±1,040
 Birth weight<2,500 g 16 (40.0)
 Birth weight<1,000 g 5 (12.5)
 Primary Santulli 2,480±1,060a)
 Secondary Santulli 2,340±1,040a)
Median age at Santulli enterostomy (day) 6 (0-292)
 Primary Santulli 2 (0-103)b)
 Secondary Santulli 71 (0-292)b)
Diseases requiring Santulli enterostomy
 Small bowel atresia 22 (55.0)
 Intestinal pseudo-obstruction 6 (15.0)
 Meconium plug syndrome 4 (10.0)
 Necrotizing enterocolitis 3 (7.5)
 Intestinal obstruction due to other disease 2 (5.0)
 Focal intestinal perforation 1 (2.5)
 Midgut volvulus 1 (2.5)
 Hirschsprung’s disease 1 (2.5)

Values are presented as n only, median (range), mean±SD, or number (%).

a) Student t-test; p=0.694.

b) Mann-Whitney U test; p<0.001.

Table 2.
Intraoperative Determinant of Performing a Santulli Enterostomy
Variable Primary Santulli Secondary Santulli Value
Luminal discrepancy 14 3 17 (42.5)
Adhesion 1 2 3 (7.5)
Preoperative functional obstruction 0 3 3 (7.5)
Severe inflammation 7 1 8 (20.0)
Not reported 3 6 9 (22.5)
Total 25 15 40

Values are presented as n only or n (%).

Fisher’s exact test; p=0.003.

Table 3.
Operative Characteristics of Santulli Enterostomy
Variable Primary (n=25) Secondary (n=15) p-value
Operation time (min) 156±48 224±95 0.019b)
Time taken to reach full enteral feeding (day) (n=22/15)a) 13 (7-392) 17 (7-127) 0.213c)
Patients with complications 3 (12.0) 3 (20.0) 0.654d)
Complications requiring re-operation 1 (4.0) 1 (6.7) 1.000d)

Values are presented as mean±SD, median (range), or n (%).

a) Three patients were excluded from the primary group because they did not survive before they achieve full enteral feeding.

b) Student t-test.

c) Mann-Whitney U test.

d) Fisher’s exact test.

Table 4.
Operative Characteristics of Santulli Closure
Variable Primary (n=22)a) Secondary (n=15) p-value
Operation time (min) 82±55 109±71 0.203b)
Time taken to reach full enteral feeding after stoma closure (day) 7.5 (4-20) 8 (5-164) 0.210c)
Stomal duration (day) 65 (16-177) 70 (21-364) 0.249c)
Follow-up duration (mo) 16 (0-135) 24 (2-136) 0.595c)
Patients with complication 1 (4.5) 8 (53.3) 0.001d)
Complications requiring re-operation 1 (4.5) 7 (46.7) 0.004d)

Values are presented as mean±SD, median (range), or n (%).

a) Three patients were excluded from the primary group because they did not survive before enterostomy closure.

b) Student t-test.

c) Mann-Whitney U test.

d) Fisher’s exact test.

Table 5.
Overall Complications Following Santulli Enterostomy and Santulli Closure
Details of complication Primary Secondary Re-operation
Santulli enterostomy
 Wound infection 2 1 -
 Stoma bleeding - 1 -
 Parastomal evisceration - 1 1
 Obstruction 1 - 1
Santulli closure
 Wound infection - 2 1
 Obstruction - 4 4
 Wound evisceration 1 2 3
Total 4 11 10
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