300 Chapter 14 In this paper, we show that in our cohort, 61% of the patients decline on the growth chart during the period that they have an enterostomy. This decline is reversed in many (67%) following enterostomy reversal. Sever malnourishment is, as could be expected due to nutrition loss and high-output enterostomy, more prevalent when treated by small bowel enterostomy (51%) than in those treated by colostomy (16%). Most specifically patients treated by a proximal small bowel enterostomy (within 50 centimeters of Treitz) and those who underwent a major small bowel resection (≥ 30 cm) seem most at risk which could be an argument for preventing an enterostomy in these patients. In our cohort patients’ early closure did not result in less growth impairment at the moment of reversal which we did expect to find. It could be that our results were influenced by the reason of early closure in our retrospective cohort which was mostly due to enterostomy complications like high-output which might have resulted in increased growth impairment in this group. Still, we did show that patients who had an early reversal and those who had a non-early reversal showed similar growth chart scores within a year following closure. It could therefore be suggested that it might be beneficial to reverse enterostomies earlier than we do at the moment. Many surgeons wait until the patient has reached a weigh above 2.5 kilograms before reversal. Other surgeons suggest early closure, within 6 to 8 weeks, because of the high occurrence of enterostomy related morbidity and associated failure to thrive. A similar result was found for patients who were and were not exposed to either a proximal bowel enterostomy or those who underwent major small bowel resection. These results suggest that enterostomy reversal seems an important factor in resolving growth impairment thus implying that the duration of growth impairment can be shortened by reversal as early as possible. Though no precise studies on this specific age group are known, it is generally accepted that delayed catch-up growth in stunted children can lead to poor motor- and cognitive outcomes later in life.[15, 16] These two papers underline the problems which could arise from treatment by enterostomy. The alternative for enterostomy formation in case of bowel resection is a primary anastomosis. We wanted to compare the complication risks of these both options in a suitable patient group. In patients treated for a jejunoileal atresia the choice between both options is made by the surgeon based on the location of the atresia. Since there is no severe inflammation, the risks of anastomotic leakage are theoretically thought to be comparatively low. However, many surgeons still create an enterostomy due to the perceived risk of this complication. In our next paper titled “Treatment of jejunoileal atresia by primary anastomosis or enterostomy: Double the operations, double the risk of complications” we compared these risks of post-operative complications. Our results
RkJQdWJsaXNoZXIy MTk4NDMw