299 Conclusions, general discussion and future perspectives Chapter 14 Firstly, we evaluated the incidence of and risk factors for major enterostomy related morbidity. We defined this as the occurrence of a Clavien-Dindo grade III or higher complication. Unlike other previous studies, we evaluated both complications following formation of the enterostomy and after enterostomy reversal. Based on both procedures we show that major enterostomy related morbidity is as high as 39%. The incidence of this morbidity is often underestimated since most studies only take enterostomy reversal into account. By disaggregating the causes of morbidity, we demonstrate that following enterostomy formation the complications mainly consist of high output enterostomy, prolapse and enterostomy stenosis. Conversely, following enterostomy closure it seems that anastomotic complications as well as adhesive obstructions are more prevalent. Ileostomy development was the only factor that was independently associated with a higher risk of developing major morbidity following enterostomy 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 enterostomy, underlying inflammatory disease, weight at closure and suture re- sorption speed were nonsignificantly related to major enterostomy related morbidity during enterostomy closure. Previous studies focusing on the subject of enterostomys in young pediatric patients have mainly focused on either necrotizing enterocolitis or anorectal malformations and Hirschsprung’s disease. Although these studies also focus on other complications associated to these diseases such as Hirschsprung associated colitis or perforations or stenosis associated with Necrotizing enterocolitis, they also underline that enterostomy related complications occur often.[12, 13] In our study, the occurrence of major enterostomy related complications leading to redo-surgery or intensive care management, did not differ significantly between patients with infectious diseases, such as NEC, and patients treated for non-infectious diseases, such as Hirschsprung’s disease. Though specific complications might differ between different diseases, our results most importantly stress the commonness of enterostomy related complications in all young patients treated with an enterostomy. These general findings on the enterostomy related morbidity further increased our interest in this specific patient’s group. We had focused on the direct morbidity that resulted from having an enterostomy, but not on the indirect morbidity. The loss of nutrients that occur because of the enterostomy is believed to result in impairment of growth. Although not clearly visible at the time, growth impairment can result in a multitude of long-term complications which are important to consider when deciding on performing an enterostomy.[14]. If in fact enterostomys do results in growth impairment, early closure (within 6 weeks) as we suggested in our previous article, might result in early catch-up growth and thereby limiting the effects of the growth impairment. These questions led to our next paper on the subject of the impact of presence, level and reversal of an enterostomy on growth.
RkJQdWJsaXNoZXIy MTk4NDMw