Santulli Enterostomy: A Considerable Method for Patients Who Require Proximal Enterostomy

Kyong Ihn; Eun-Jung Koo; In Geol Ho; Seok Joo Han; Jung-Tak Oh

doi:10.13029/jkaps.2018.24.1.20

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

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

Original Article

J Korean Assoc Pediatr Surg 2018;24(1):20-25.

Published online: 30 June 2018

DOI: https://doi.org/10.13029/jkaps.2018.24.1.20

Santulli Enterostomy: A Considerable Method for Patients Who Require Proximal Enterostomy

Kyong Ihn, Eun-Jung Koo, In Geol Ho, Seok Joo Han, Jung-Tak Oh

Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence: Jung-Tak Oh, Department of Pediatric Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-2124, Fax: +82-2-313-8289, E-mail: jtoh@yuhs.ac

Received 9 May 2018 Revised 7 June 2018 Accepted 7 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Enterostomy, Neonate, Necrotizing enterocolitis, Intestinal atresia, Peritonitis

REFERENCES

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Fig. 1.

Flowchart showing the study design including 40 patients enrolled in this study.

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±1,060^a)
Secondary Santulli	2,340±1,040^a)
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	0.019^b)
Time taken to reach full enteral feeding (day) (n=22/15)^a)	13 (7-392)	17 (7-127)	0.213^c)
Patients with complications	3 (12.0)	3 (20.0)	0.654^d)
Complications requiring re-operation	1 (4.0)	1 (6.7)	1.000^d)

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	0.203^b)
Time taken to reach full enteral feeding after stoma closure (day)	7.5 (4-20)	8 (5-164)	0.210^c)
Stomal duration (day)	65 (16-177)	70 (21-364)	0.249^c)
Follow-up duration (mo)	16 (0-135)	24 (2-136)	0.595^c)
Patients with complication	1 (4.5)	8 (53.3)	0.001^d)
Complications requiring re-operation	1 (4.5)	7 (46.7)	0.004^d)

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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