231 Major stoma related morbidity in young children following stoma formation and closure Chapter 10 Characteristic Count (total = 292) Clavien Dindo 3 Clavien Dindo 4 Clavien Dindo 5 Stoma related morbidity, n (%) 47 (16) 35 11 1 Type of morbidity, n (%) Incisional hernia 17 (6) 15 2 Anastomotic stenosis 13 (5) 9 3 1 Adhesive obstruction 12 (4) 7 5 Correction scar tissue 3 (1) 3 Enterocutaneous fistula (from old stoma) 2 (1) 1 1 Overall stoma related morbidity, n (%) 66 (23) *Relaparotomy without additional resection (n=2), septic arthritis (n=1), perforation after dilatation (n=1), anastomosis during stoma closure, removal NG tube sigmoid (n=1), 1x additional resection sigmoid, dehydration (n=1), torsion after Duhamel (n=1), bleeding (n=1) ≠Patients that died within 30 days after stoma closure not included in the analysis (n=4) Discussion Major stoma related morbidity, leading to redo surgery, intensive care admission or death, was high in this retrospective study including 336 young children. Following stoma formation, 27% (n=92/336) of the young children experienced major stoma related morbidity, mainly consisting of high output stoma, prolapse and stoma stenosis. The major morbidity rate was 23% (n=66/292) following stoma closure, most commonly comprising anastomotic leakage/stenosis, incisional hernia and adhesive obstructions. For combined stoma interventions, major stoma related morbidity was 39% (n=130/336). The rate of this morbidity was stable over the years. Ileostomy was the only factor that was independently associated with a higher risk of developing major morbidity following stoma formation (OR:2.5; 95%-CI:1.3-4.7) as well as following closure (OR:2.7; 95%-CI:1.3-5.8). Duration of stoma, underlying inflammatory disease, weight at closure and suture resorption speed were non-significantly related to major stoma related morbidity during stoma closure. The most common complications following stoma formation was a high output stoma, which can result in malnutrition. Prolonged malnutrition, due to nutrient and fluid loss via a stoma, can negatively impact growth and adverse cognitive development.[15, 16] It is reported that in the presence of a stoma, up to 90% of the young children are declining on the growth chart, which is why some advocate early stoma closure.[17-20] This opinion is supported by the finding that most young children thrive after stoma closure, irrespective of morbidity, weight, or underlying pathology.[17] Considering the increased risk of malnutrition due to stoma morbidity and its impact on growth, it is interesting to see that weight at stoma closure and days until stoma closure were not significantly associated with morbidity following closure in our cohort. This
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