225 Major stoma related morbidity in young children following stoma formation and closure Chapter 10 Introduction Stoma creation can be necessary and lifesaving in young children with a bowel perforation, necrosis or obstruction.[1, 2] In these critically ill children, a stoma is often created instead of a primary anastomosis to avoid the risk of anastomotic leakage. Stoma formation can result in major stoma related morbidity such as stoma necrosis, stenosis, prolapse, and incisional or parastomal hernia[3]. Additionally, excessive fluid loss might lead to dehydration and failure to thrive most specifically in case of ileostomies. [4, 5] Most stomas are reversed, which means that these young children undergo a second surgery, after which anastomotic leakage or other complications might still occur. Overall stoma related morbidity is reported to occur in 20-38% of pediatric patients taking into account both stoma formation and closure.[2, 3, 6] The true incidence of major stoma related morbidity cannot reliably be established based on the currently available studies because of small cohort sizes.[2, 3, 6] Identification of risk factors for major stoma related morbidity could aid in the development of preventative strategies, or might lead to changes in surgical approaches. Previous studies identified a lower weight at stoma closure as a risk factor for postoperative morbidity in patients treated for necrotizing enterocolitis.[3] However, other studies could not confirm low weight as a risk factor for morbidity following stoma closure.[7-9] In addition, prematurity and underlying inflammatory disease have been reported to be correlated to stoma morbidity.[5, 10, 11] Large cohort studies are needed to more reliably define relevant risk factors. Thus, the aim of this study was to assess major stoma related morbidity and its associated risk factors, both after stoma formation and stoma closure. Methods Patients and management All young children (age ≤ three years) that received a stoma between January 1998 and December 2018 at our tertiary referral center were retrospectively identified. The ethical committee of the Amsterdam university medical center approved the study protocol (reference number: W18_233#18.278). Patients and parents received an opt-out letter for consent. Following consent, patient records were checked for eligibility. Data was retrieved and stored in an electronic database (Castor EDC).
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