Purpose

To provide an overview of complications after ileostomy or colostomy procedures in children, and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation, Hirschsprung’s disease, pediatric intestinal pseudo-obstruction (PIPO)) and children without motility disorders (including necrotizing enterocolitis, anorectal malformation and inflammatory bowel disease).

Methods

We performed a retrospective study of children who underwent an enterostomy procedure at our institution. The number and type of complications and subsequent reoperations after ostomy formation were determined. Complications were scored using the Clavien–Dindo classification. A complication of ≥ grade III-b was considered a high-grade complication.

Results

129 children with an ileostomy and 61 children with a colostomy were included. Of these, 62 children (32.6%) had motility disorders; functional constipation (n = 40), Hirschsprung’s disease (n = 18) and PIPO (n = 4). The total prevalence of complications was 73.2%. Comparing the perioperative data, children with motility disorders significantly more often underwent a laparoscopic procedure (59.7% vs. 10.9%, p = 0.000) and had an end stoma-configuration (37.1% vs. 14.1%, p = 0.000) as compared to children without motility disorders. Children with motility problems had a higher complication rate (88.7% vs. 65.5%, OR 4.1, 95% CI 1.7–9.8, p = 0.001) compared to children without motility problems, and a larger proportion of complications was classified as high-grade complications (61.8% vs. 31.0% p = 0.002).

Conclusion

A high complication rate after enterostomy formation was detected. Children with gastrointestinal motility disorders had more and more severe complications as compared to children without motility disorders.

Level of evidence

Level III

Type of study

Retrospective comparative study

中文翻译：

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患有和不患有运动障碍的儿童进行肠切开术后的结果：术后并发症的描述和比较。

目的

提供儿童回肠造口术或结肠造口术后的并发症的概述，并比较患有肠胃蠕动障碍（即功能性便秘，Hirschsprung病，小儿假性肠梗阻（PIPO））和无运动障碍（包括坏死性小肠结肠炎）的儿童的结局，肛门直肠畸形和炎症性肠病）。

方法

我们对在我们机构接受肠造口手术的儿童进行了回顾性研究。确定了造口术形成后并发症的数量和类型以及随后的再手术。使用Clavien-Dindo分类对并发症进行评分。≥III-b级并发症被认为是高度并发症。

结果

其中包括129例回肠造口术儿童和61例结肠造口术儿童。其中62名儿童（32.6％）患有运动障碍；功能性便秘（n  = 40）， 赫氏弹簧病（n = 18）和PIPO（n = 4）。并发症的总患病率为73.2％。比较围手术期数据，与运动能力障碍儿童相比，腹腔镜手术的发生率明显更高（59.7％vs. 10.9％，p = 0.000），并具有最终的造口构型（37.1％vs. 14.1％，p = 0.000）。儿童没有运动障碍。与没有运动问题的儿童相比，有运动问题的儿童的并发症发生率更高（88.7％vs. 65.5％，或4.1，95％CI 1.7–9.8，p = 0.001），并且较大比例的并发症被归为高等级并发症（61.8％vs. 31.0％p = 0.002）。

结论

肠造口形成后的并发症发生率很高。与没有动力障碍的儿童相比，患有胃肠动力障碍的儿童并发症越来越严重。

证据水平

第三级

学习类型

回顾性比较研究