Double-barreled enterostomy with compression anastomosis in newborns and infants

Abstract

BACKGROUND: Staged treatment of small bowel diseases involves the formation of an enterostomy. BishopKoop T-anastomosis and Mikulicz double-barreled enterostomy with compression clamp are widely applied. The disadvantages of Mikuliczs can be eliminated using a clip of titanium nickelide with shape memory instead of a clamp. AIM: This study aimed to evaluate the efficacy and safety of a titanium nickelide device in double-barreled enterostomy and compare the results of treatment with a T-anastomosis. MATERIALS AND METHODS: The study included newborns and infants. The clip was applied on 958 days postoperatively. Differences were accepted as significant at p 0.05. RESULTS: Since 2000, enterostomy was performed in 79 children: 12 (15.2%) had T-anastomoses, 44 (55.7%) had double-barreled stomas, and 18 (40.9%) had a titanium nickelide clip. In the study groups, stomas were applied for ileus, atresia, and aganglionosis. In the group of double-barreled enterostomies with a clip, the stoma was closed later (p = 0.027) and the operation time was short (p = 0.013). In the T-anastomosis group, parenteral nutrition was required for a longer period (p = 0.018). Self-removal of the clip and appearance of the stool occurred on days 5 and 13. Compression anastomosis was obtained in 83.3% and stoma closure outside in 73.3%. With a double-barreled enterostomy, hepatic failure (p = 0.018) and anastomosis dysfunction (p = 0.046) were less common. T-anastomosis revealed an increase in the incidence of CDC II (p = 0.013) and III (p = 0.015) complications. DISCUSSION: The results reflect the safety of the presented method in comparison with the T-anastomosis, since the operation time and duration of the parenteral nutrition are reduced, invasive treatment is less often required for complications, and anastomosis dysfunction rarely occurs. CONCLUSIONS: Double-barreled enterostomy with a compression clip is an effective and safe alternative to T-anastomosis in children aged 1 year. The formed compression anastomosis allows closure of the stoma by suturing its outer part. The conditions for the formation of the anastomosis are the patency of the distal sections and bowel diameter 1 cm.