Outcome of Santulli enterostomy in patients with immaturity of ganglia: single institutional experience from a case series
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Immaturity of ganglia (IG) is an extremely rare disease and always requires surgical intervention in the neonatal period, but without guidelines to choose the ideal enterostomy procedure, the timing of stoma closure remains controversial. The aim of this study was to report our experience using Santulli enterostomy for the treatment of nine infants diagnosed with IG.Patients who underwent Santulli enterostomy and were diagnosed with IG in our center between 2016 and 2021 were retrospectively studied. Temporary stoma occlusion and a 24-h delayed film of barium enema (BE) were performed to evaluate intestinal peristalsis function to determine the timing of stoma closure. The demographic data, clinical and radiological findings, stoma occlusion and stoma closure results were explored.A total of 9 infants underwent Santulli enterostomy and were diagnosed with IG postoperatively. Their median gestational age at birth was 36 weeks (range 31-42), and their median birth weight was 2765 g (range 1300-3400). All patients had symptom onset in the neonatal period, including abdominal distension and biliary vomiting. Eight patients showed obvious small bowel dilatation in the plain films, except for one patient's films that suggested gastrointestinal perforation with free gas downstream of the diaphragm. BE was performed in 6 patients, all of which had microcolons. The median age at operation was 3 days (range 1-23). Seven patients had an obvious transitional zone (TZ) during laparotomy, and the position of the TZ was 25-100 cm proximal above the ileocecal (IC) valve. Immature ganglion cells were present in the colon in 7 patients and the terminal ileum in 6 patients. The median age of successful stoma occlusion was 5 M (range 2-17) and 8 M (range 4-22) at ostomy closure. There was little or no barium residue in the 24-h delayed film of BE before stoma closure, and all patients were free of constipation symptoms during the follow-up.Santulli enterostomy appears to be a suitable and efficient procedure for IG, combined with temporary stoma occlusion and 24-h delayed film of BE to evaluate the recovery of intestinal peristalsis function.Keywords:
Stoma (medicine)
Abdominal distension
Ileostomy
Enterostomy
Perforation
Jejunostomy
Background: In elective and emergency general surgery, bowel anastomoses are common procedures. Although several stoma-related issues may arise following stoma creation, establishing a stoma is incredibly morbid. Aims and Objectives: The study compares patients with diversion ileostomies (stomas) to those who had to cover ileal loops without ostomies or delayed ostomies for large bowel anastomosis to compare the risks and advantages of each procedure. Materials and Methods: This prospective and comparative study was conducted on 50 patients undergoing large bowel anastomosis. Patients were divided into two groups: Group A: Those with covering ileal loop without or delayed ostomy, and Group B: Those undergoing diversion ileostomy. Results: Demographic data of the study indicated that most of the participants in both groups were male (72% in covering ileal loop and 64% in diversion ostomy). In both groups, most participants belonged to the >45 age group. We have seen a significant difference in the setting of surgery, Vitamin B 12 levels, early complications, late complications, and time of takedown comparing covering ileal loop to the diversion ostomy group. Conclusion: This study showed reduced postoperative morbidity and complications of stomas following covering ileal loop compared to diversion ileostomy. Hence, the technique should be considered.
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Can a person with an intestinal stoma lead a normal life? Most patients can. But they must be rehabilitated quickly. If patients undergoing colostomy are instructed before and after surgery about irrigating the stoma, most can stop using an appliance in days or weeks. Patients with ileostomies present more of a problem, but they too can return to a useful life.
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Abstract Ileostomy is a commonly performed procedure for colon surgeries and the following emergency small or large bowel resection and anastomosis. We proposed a successful new technique of covering ileal loop without opening it, to decrease the stoma and reversal-related complications.
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Each year an estimated 13 500 stoma surgeries are carried out in the UK ( Kettle, 2019 ). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications.
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The early post-ileostomy medical management of neonates is not clearly defined. A retrospective chart review of all infants who received an ileostomy March 2010-December 2011, identified the post-operative ileostomy progress of each infant. There were 16 cases of neonatal ileostomy during the study period. Over the first 14 postoperative days there was no weight gain. By 21 days the infants were gaining a median 140 g/week. The median stoma output was 5 mls/kg/dy during the first 7 days increasing to 17.5-20 mIs/kg/dy. Weight gain or weight loss was closely related to the consistency and volume of the stoma output. Ten infants had a hig stoma output > 20 mls/kg/dy (3 preterm, 7 term). This high stoma output was associated with sub-optimal weight gain. This study provides a template for the expectant management of newborn infants after an ileostomy. The critical issues are weight gain, stoma output and local and systemic complications.
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Establishment of an artificial intestinal outlet is even nowadays associated with a more than 50% postoperative morbidity. More frequent surgical complications are described in colostomies, patients with ileostomies are threatened more by a metabolic breakdown due to fluid loss via the stoma. This complication threatens patients with ileostomy not only in the early postoperative period but may represent also a long-term problem in particular in risk patients. The authors evaluated complications associated with establishment of an artificial outlet of the gut in 88 patients operated in 1999-2000. Complications were more frequently recorded in patients with colostomy, i.e. in 9.7%. In 80.8% patients with ileostomies fluid losses via the stoma exceeding 1000 ml/24 hours were observed. Early and systematic replacement of water and minerals prevented the development of serious metabolic and circulatory disorders. The authors consider a priority solution in particular in temporary derivation of the intestinal passage establishment of an ileostomy despite the risk of metabolic complications.
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Among the considerations in making the decision for proctocolectomy in ulcerative colitis is the hazard of ileostomy. Since our current techniques for constructing an ileostomy were developed less than 20 years ago, the long-term risks associated with a permanent ileal stoma cannot yet be assessed. Nevertheless, periodic follow-up information on ileostomy patients is of value when operation is being considered for a patient with chronic ulcerative colitis. In this report attention has been focused on the frequency and type of ileostomy complications which require a corrective operation.
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The case histories of all patients who had a permanent ileostomy established during the 20-year period ending Dec 31, 1967, were reviewed. Patients in whom the ileal stoma was constructed because of chronic ulcerative colitis were selected for study. Cases in which the ileal stoma was made because of granulomatous colitis were excluded. Using these criteria a total of 88 cases wereIleostomy
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Introduction Although medical management of Crohn’s disease has changed in recent years, it is unclear whether surgical management has altered. We examined rate changes of surgical interventions, stoma constructions, and subset of ileostomy and colostomy constructions. Materials and Methods We reviewedthe NationwideInpatient Sampledatabasefrom1988to2011.We examinedthe number of Crohn’s-related operations and stoma constructions, including ileostomies and colostomies; a multivariable logistic regression model was developed. Results A total of 355,239 Crohn’s-related operations were analyzed. Operations increased from 13,955 in 1988 to 17,577 in 2011, p<0.001. Stoma construction increased from 2493 to 4283, p<0.001. The subset of ileostomies increased from 1201 to 3169, p<0.001 while colostomies decreased from 1351 to 1201, p=0.05. Operation percentages resulting in stoma construction increased from 18 to 24 %, p<0.001. Weight loss (OR 2.25, 95 % CI 1.88, 2.69) and presence of perianal fistulizing disease (OR 2.91, 95 % CI 2.31, 3.67) were most predictive for requiring stoma construction. Conclusions Crohn’s-related surgical interventions and stoma constructions have increased. The largest predictors for stoma construction are weight loss and perianal fistulizing disease. As a result, nutrition should be optimized and the early involvement of a multidisciplinary team should be considered.
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