The timing of enterostomy reversal after necrotizing enterocolitis

Background/Purpose

Newborns undergoing surgery for necrotizing enterocolitis (NEC) often require a stoma. The study purpose is to determine if the timing of stoma closure impacts the postoperative course.

Methods

After obtaining institutional review board approval, records of patients with NEC who received a stoma between 2003 and 2007 at 2 pediatric institutions were reviewed. Data collected included time interval between stoma creation and closure, indication for closure, postoperative complications, time to feeds, and length of neonatal intensive care unit and hospital stays. For analysis purposes, patients were divided in 2 groups: 1, stoma closed within 10 weeks; and 2, stoma closed more than 10 weeks after construction.

Results

There were 37 patients: 13 in group 1 and 24 in group 2. Group 1 babies were ventilated longer postoperation (7.69 vs 1.08 days, P = .0006). They required total parenteral nutrition for more days (51.62 vs 16.30 days, P = .0486). Group 1 patients took longer to reach full po (19.08 vs 7.86 days, P = .027), and they had a longer length of stay postreversal (113.08 vs 31.32 days, P = .0373). No differences were observed in survival rates or anastomotic complications.

Conclusion

The timing of stoma reversal significantly impacts the postoperative course after NEC. Unless seriously indicated, stoma closure should be deferred until at least 10 weeks postcreation.