Neonatal enterostomy is usually performed in children with critical acute abdomen. The stoma is mostly temporary (including in loop enterostomy, double barrel enterostomy, exteriorization, and single port surgeries).Its purpose is to ensure defecation with proximal enterostomy, reduce intestinal pressure, control infection and stabilize infants for further treatment. However this treatment is also associated with serious complications including postoperative incision infection, incisional hernia, surrounding inflammation and intestinal prolapse .
Some complications tend to occur long after surgery. Incision infection and surrounding inflammation are the two most common complications, for the following reasons:1) the position of the stoma and the wound are too close: and 2)peristomal dermatitis is known to be influenced by the distance from the ligament of Treitz [5, 8]. The higher the position of the stomar, is the more alkaline the intestinal fluid, which promotes the development of skin disorders.According to previous research peripheral dermatitis and incision infection account for more than half of all complications[4, 6], that seriously endanger the life and health of infants.Studies have found that the incidence of postoperative SSI is 0.7%~16.6%, which could directly lead to prolonged hospitalization and increase the risk of death[9–10].
Since many complications are associated with exposure to intestinal fluid, we wondered if it would be possible to completely separate the intestinal fluid from the wound. We were inspired by circumcision procedures. Circumcision is based on the principle of chronic cutting of elastic lines with delayed shedding of the circumcision ring, resulting in formation of a regular incision for healing[11–14]. We assembled a simple intestinal ostomy drainage device with foreskin cerclage staple, elastic thread a condom and mousse thread.The foreskin ring was fixed on the stomata with an elastic line and automatically fell off 5–7 days after the operation. During this period, thestoma fluid was drained to the area outside the wound through the condom, which was completely isolated from the surgical incision, thus effectively preventing complications such as wound infection, incisional hernia and peripheral dermatitis.In our study, one patient died of multiple organ failure due to postoperative septic shock, and one patient underwentstoma surgery before the procedure because of excessive orifice wear and excessive intestinal fluid flow.There were no obvious complications in the remaining patients.In clinical practice, we found that our enterostomy drainage device has the following advantages: 1) the surgical incision can be effectively isolated and healing time is adequate; 2) delayed shedding of the wrapping ring prevents the need for replacement of the artificial pocket, not only decreasing medical costs, but also reducing nursing workload; 3)the transparency of the condom allows observation of the characteristics of intestinal fluid and exhaust, making nursing more convenient; 4༉circumcision style detachment allows the formation an intestinal tube with a more regular shape, which is conducive to the closure of pocket.
Neonatal enterostomy technology often requires experienced doctors and the operation, is difficult. Our operation method simplifies the treatment of ostomy tubes, the operation method is simple, and is easy to master even for beginners.The surgical techniques can be summarized as follows: 1)An appropriate foreskin ring should be chosen according to the diameter of the intestinal tube: usually the diameter of the circumcision ring needs to be slightly smaller than the diameter of the intestinal tube; 2༉The condom used needs to be colorless and transparent, and thus convenient for postoperative observation; 3༉Elastic line must be used rather than a mousse line, and the line knot must not be too tight. If it is too tight. It can easily causes the prepuce ring to fall off prematurely, and thus effective wound isolation wound not be achieved; 4༉The exposed orifice tube should be 2–3 cm long, a longer length can cause intestinal tube prolapse; 5༉Vaseline gauze should be used to wrap the orifice tube after the operation to avoid excessive drying and to protect the intestinal tube from mechanical damage.
Although the present study only included a small number of patients, Periostomy dermatitis occurred in only one patient with an incidence of 5.26%, suggesting the effectiveness of the procedure. We think this method has no significant effect on long-term complications such as intestinal prolapse and improvement ofstoma flow.However, whether there is an improvement in incidence of intestinal prolapse and other complications still needs to be further confirmed by multicenter studies and studies with a large sample size.