Retrospective Study
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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1101-1110
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1101
Table 1 Primary disease
n (%)Group 1 NEC 51 (67.1) Group 2 Other gastrointestinal disorders 25 (32.9) MI with CF 8 (10.5) MI without CF 2 (2.6) ARM 7 (9.2) FIP 3 (3.9) Ileus of unknown origin 2 (2.6) Intestinal atresia 2 (2.6) Volvulus 1 (1.3)
Table 2 Comparison of group populations n (%)
Overall population Group 1 Group 2 P -valuen (%)76 (100) 51 (67.1) 25 (32.9) Female 42 (55.3) 29 (56.9) 13 (52.0) 0.877 Gestational age (wk) 27 (22-41) 27 (23-38) 28 (22-41) 0.637 Preterm infants 66 (86.8) 46 (90.2) 20 (80.0) 0.282 Weight at birth (g) 840 (430-3400) 850 (490-3370) 825 (430-3400) 0.709 Deceased patients 3 (3.9) 2 (3.9) 1 (4.0) 1 Comorbidities Cardiovascular system insufficiency 23 (30.3) 19 (37.3) 4 (16.0) 0.103 Bronchopulmonary dysplasia 17 (22.4) 13 (25.5) 4 (16.0) 0.522 Respiratory insufficiency 54 (71.1) 39 (76.5) 15 (60.0) 0.223 Recurrent sepsis 13 (17.1) 8 (15.7) 5 (20.0) 0.885 Septic shock 9 (11.8) 8 (15.7) 1 (4.0) 0.257 Congenital malformations 12 (15.8) 3 (5.9) 9 (36.0) 0.002 Age at enterostomy formation (d) 9.5 (1-101) 11 (2-75) 4 (1-101) 0.004 Weight at enterostomy formation (g) 1025 (450-3780) 1010 (450-3780) 1310 (480-3360) 0.373
Table 3 Enterostomy formation n (%)
Overall population Group 1 Group 2 P -valueEnterostomy location Jejunostomy 3 (3.9) 2 (3.9) 1 (4.0) 1 Ileostomy 63 (82.9) 47 (92.2) 16 (64.0) 0.007 Colostomy 10 (13.2) 2 (3.9) 8 (32.0) 0.002 Stoma duration (wk) 12.5 (0-90) 12 (0-35) 14 (1-90) 0.468 Days until initiation of enteral nutrition 4 (1-13) 5 (3-13) 3 (1-9) < 0.001 Requiring PN until closure 15 (21.1) 9 (18.8) 6 (26.1) 0.541 Full enteral nutrition prior to reversal 56 (78.9) 39 (81.3) 17 (73.9) 0.541 Days until full enteral nutrition 24.5 (6-209) 22 (6-87) 29 (8-209) 0.288 Days until stool via enterostomy 4 (2-27) 4 (2-14) 5 (2-27) 0.918
Table 4 Complications of enterostomy formation n (%)
Overall population Group 1 Group 2 P -valuePatients with ≥ 1 complication 62 (80.3) 44 (86.3) 17 (68.0) 0.073 Complications 152 110 42 Skin excoriation 37 (48.7) 27 (52.9) 10 (40.0) 0.414 Blister 1 (1.3) 1 (2.0) 0 (0.0) 1 Wound discharge 15 (19.7) 12 (23.5) 3 (12.0) 0.359 Wound bleeding 30 (39.5) 21 (41.2) 9 (36.0) 0.854 Prolapse 29 (38.2) 22 (43.1) 7 (28.0) 0.305 Wound dehiscence 1 (1.3) 0 (0.0) 1 (4.0) 0.329 Insufficient circulation of enterostomy 17 (22.4) 10 (19.6) 7 (28.0) 0.595 Necrosis of enterostomy 4 (5.3) 4 (7.8) 0 (0.0) 0.296 Mechanical ileus 8 (10.5) 4 (7.8) 4 (16.0) 0.388 Parastomal hernia 1 (1.3) 1 (2.0) 0 (0.0) 1 Prestomal obstruction/stenosis 10 (13.2) 8 (15.7) 2 (8.0) 0.482 Perforation 1 (1.3) 1 (2.0) 0 (0.0) 1 Abdominal compartment syndrome 1 (1.3) 1 (2.0) 0 (0.0) 1 Failure to thrive under enterostomy 16 (21.9) 10 (20.4) 6 (25.0) 0.885 Patients with ≥ 1 reoperation 9 (11.8) 6 (11.8) 3 (12.0) 1 Mechanical ileus 7 (9.2) 3 (5.9) 4 (16.0) 0.069 Insufficient improvement of health 3 (3.9) 3 (5.9) 0 (0.0) 0.505 Abdominal compartment syndrome 1 (1.3) 1 (2.0) 0 (0.0) 1 Intestinal perforation 2 (2.6) 2 (3.9) 0 (0.0) 1 Colon necrosis 1 (1.3) 1 (2.0) 0 (0.0) 1
Table 5 Onset of most common enterostomy complications
Overall population Group 1 Group 2 P -valueSkin excoriation 27 (6-143) 26 (6-103) 31.5 (10-143) 0.098 Wound bleeding 12.5 (2-128) 11 (2-128) 14 (2-71) 0.79 Prolapse 57 (5-165) 60.5 (5-165) 52 (5-119) 0.901
Table 6 Number of enterostomy formation-related complications in one patient n (%)
Overall population Group 1 Group 2 P -valueNone 15 (19.7) 7 (13.7) 8 (32.0) 0.073 1 16 (21.1) 12 (23.5) 4 (16.0) 0.648 2 18 (23.7) 13 (25.5) 5 (20.0) 0.809 3 13 (17.1) 8 (15.7) 5 (20.0) 0.748 4 10 (13.2) 8 (15.7) 2 (8.0) 0.482 5 3 (3.9) 2 (3.9) 1 (4.0) 1 6 0 (0.0) 0 (0.0) 0 (0.0) 7 1 (1.3) 1 (2.0) 0 (0.0) 1 ≥ 4 14 (18.4) 11 (21.6) 3 (12.0) 0.365
Table 7 Enterostomy closure n (%)
Overall population Group 1 Group 2 P -valueEarly reversal necessary 28 (38.4) 19 (38.8) 9 (37.5) 1 Failure to thrive under enterostomy 12 (16.4) 7 (14.3) 5 (20.8) 0.432 Prolapse 7 (9.6) 4 (8.2) 3 (12.5) 0.646 Stenosis of enterostomy 4 (5.5) 3 (6.1) 1 (4.2) 1 Necrosis of enterostomy 1 (1.4) 1 (2.0) 0 (0.0) 1 Parastomal hernia 1 (1.4) 1 (2.0) 0 (0.0) 1 As part of a not enterostomy-related surgery 3 (4.1) 3 (6.1) 0 (0.0) 0.53 Days until initiation of enteral nutrition 2 (1-18) 2 (1-18) 2 (1-6) 0.151 Days until full enteral nutrition 8 (3-93) 8 (3-93) 7 (4-41) 0.966 Days to rectal stool 3 (1-13) 3 (1-12) 3 (2-13) 0.732
Table 8 Complications of enterostomy closure n (%)
Overall population Group 1 Group 2 P -valuePatients with ≥ 1 complication 19 (26.0) 15 (30.6) 4 (16.7) 0.321 Mechanical ileus 8 (11.0) 4 (8.2) 4 (16.2) 0.426 Subcutaneous hematoma 1 (1.4) 1 (2.0) 0 (0.0) 1 Wound dehiscence with intestinal prolapse 1 (1.4) 0 (0.0) 1 (4.2) 0.329 Wound infection 3 (4.1) 3 (6.1) 0 (0.0) 0.546 Postoperative infection 4 (5.5) 4 (8.2) 0 (0.0) 0.299 Seroma of laparotomy wound 1 (1.4) 1 (2.0) 0 (0.0) 1 Anastomotic leakage 2 (2.7) 2 (4.1) 0 (0.0) 1 Patients with ≥ 1 reoperation 10 (13.7) 6 (12.2) 4 (16.7) 0.72 Mechanical ileus 8 (11.0) 4 (8.2) 4 (16.7) 1 Wound dehiscence with intestinal prolapse 1 (1.4) 0 (0.0) 1 (4.2) 0.455 Anastomotic leakage 2 (2.7) 2 (4.1) 0 (0.0) 0.455
Table 9 Clavien-Dindo-Classification n (%)
Overall population Group 1 Group 2 P -valueI 31 (42.5) 23 (46.9) 8 (33.3) 0.399 II 6 (8.2) 6 (12.2) 0 (0.0) 0.169 IIIa 0 (0.0) 0 (0.0) 0 (0.0) IIIb 14 (19.2) 9 (18.4) 5 (20.8) 1 IVa 11 (15.1) 6 (12.2) 5 (20.8) 0.489 IVb 0 (0.0) 0 (0.0) 0 (0.0) V 0 (0.0) 0 (0.0) 0 (0.0)
Table 10 Associations with the occurrence of severe enterostomy-related complications
CDC < III CDC ≥ III P -valuen (%)48 (65.8) 25 (34.2) Gestational age (wk) 27 (23-38) 26 (22-41) 0.931 Birth weight (g) 867.5 (430-3370) 812 (460-3400) 0.591 Preterm infants 43 (89.6) 21 (84.0) 0.481 Age at enterostomy formation 9 (1-75) 16 (1-101) 0.159 Weight at enterostomy formation 1005 (480-3780) 1600 (450-3360) 0.699 Days until initiation of enteral nutrition after formation 4 (1-13) 4 (1-9) 0.29 Patients requiring PN until reversal 7 (14.6) 8 (32.0) 0.135 Days until full enteral nutrition after formation 24.5 (6-87) 25 (10-209) 0.634 Days until stool via enterostomy (wk) 4 (2-12) 5 (2-27) 0.487 Duration of enterostomy (wk) 13 (0-90) 12 (0-58) 0.682 Early reversal necessary 12 (25.0) 16 (64.0) 0.003 Days until initiation of enteral nutrition after reversal 2 (1-8) 2 (1-18) 0.389 Days until full enteral nutrition after reversal 7 (3-87) 12 (5-93) 0.006 Days to rectal stool 3 (1-12) 4 (1-13) 0.645
Table 11 Effect of complications on clinical course
Reoperation CDC ≥ III Early reversal Formation Skin excoriation 0.736 1 0.882 Blister 0.12 0.342 1 Wound discharge 1 1 1 Wound bleeding 1 0.759 0.498 Prolapse 1 0.774 1 Wound dehiscence 1 1 1 Insufficient circulation of enterostomy 0.205 0.99 0.577 Necrosis of enterostomy 0.068 0.269 0.052 Mechanical ileus < 0.001 0.001 1 Parastomal hernia 0.12 0.342 0.384 Obstruction/stenosis 0.094 0.026 0.492 Perforation 0.12 1 1 Abdominal compartment syndrome 0.12 0.342 0.384 Failure to thrive under enterostomy 0.676 0.99 < 0.001 Reversal Mechanical ileus < 0.001 < 0.001 Subcutaneous hematoma 1 1 Wound dehiscence with intestinal prolapse 0.137 0.342 Wound infection 0.362 0.269 Postoperative infection 1 1 Seroma of laparotomy wound 1 1 Anastomotic leakage 0.014 0.108