A. C. Greene1, O. Ziegler1, K. M. Gimbel2, J. M. Hughes2, M. J. Stack1, M. C. Santos3, D. V. Rocourt3 1Penn State Hershey Medical Center, Department Of Surgery, Hershey, PA, USA 2Penn State University College Of Medicine, Hershey, PA, USA 3Penn State Children’s Hospital, Division Of Pediatric Surgery, Hershey, PA, USA
Introduction: Necrotizing enterocolitis (NEC) is a severe gastrointestinal condition that predominantly affects premature neonates. These neonates can progress to develop perforation or fulminant NEC, often requiring surgical intervention including laparotomy with enterostomy or stoma formation. The optimal timing for stoma reversal remains unclear. Our study aims to evaluate the outcomes associated with early versus late stoma reversal in infants who underwent surgical intervention for NEC.
Methods: We conducted a retrospective review of premature infants with NEC at a tertiary children’s hospital from 2011 to 2022. The study included patients that have required operative intervention with creation and subsequent reversal of a stoma. Patient characteristics and clinical outcomes were reviewed and compared based on the timing of the stoma reversal.
Results: There were 36 patients (66.7% male, gestational age at birth 27.5 ± 3.6 weeks) with NEC who met the operative inclusion criteria. Patients were stratified into three groups based on the timing of stoma reversal: <8 weeks (27.8%, n=10), 8-12 weeks (33.3%, n=12), and >12 weeks (38.9%, n=14). The primary surgical indication for NEC was perforation (52.8%), with ileostomy being the predominant diversion method (69.4%). Infants who underwent earlier reversal were of lower weight compared to those reversed later (<0.001). Total length of stay (LOS) was shortest for patients reversed at 8-12 weeks (98.6 ± 33.2 days) compared to patients reversed at <8 weeks (124 ± 46 days) and >12 weeks (147.7 ± 58.2 days). There was no difference in repeat NEC events after reversal (p=0.22), ability to reach full feeds (p=0.86), or complications within 30 days (p=0.74) based on timing of stoma reversal.
Conclusion: Infants who underwent stoma reversal between 8-12 weeks after creation had a decreased LOS with comparable clinical outcomes, highlighting the potential benefits of this timing strategy.