Zornoza-Moreno M, Ruiz-Montañez JA

Language: Spanish
References: 20
Page: 216-223
PDF size: 713.63 Kb.

ABSTRACT

Objective: To present and describe a feedback technique in children with ileostomy that allows to increase the growth curve and decrease anastomotic dehiscence and postoperative dermatitis.
Material and Methods:We present 7 patients with ileostomy, treated with the refeeding technique during 2014 in the ColorectalCenter. We review why the derivation was performed, the age and the weight when the refeeding was begun, the weight gained, how long the refeeding was carried out, the macroscopic findings during the ileostomy closure and the outcome.
Results: Four patients had intestinal atresia, 1 patient was suspected of Hirschsprung's disease, one had necrotizing enterocolitis and another had an intestinal intussusception with intestinal damage. The refeeding was begun at 5 months old on average and with 4.4kg on average. The weight gain was 0.7kg per month on average (range 0.36- 1.4kg per month). We found no disproportion between the bowel segments. There was neither anastomotic dehiscence nor postoperative perianal dermatitis. After 2 years of follow-up, 6 patients have normal weight curve and normal height curve for their age.
Conclusions: The refeeding is an easy, safe and inexpensive technique to increase the patient weight gain, to prevent the atrophy of the intestinal segment, to reduce fluid and electrolyte loss and to prepare the bowel for the future intestinal anastomosis.

REFERENCES

1. Shawis R, Antao B. Prenatal bowel dilatation and the subsequent postnatal management. Early Hum. Dev. 2006;82(5):297-303. doi:10.1016/j.earlhumdev. 2006.02.005.

2. De la Hunt M. The acute abdomen in the newborn. Semin. Fetal Neonatal Med. 2006;11(3):191-7. doi:10.1016/j. siny.2006.01.004.

3. Hajivassiliou C. Intestinal obstruction in neonatal/pediatric surgery. Semin. Pediatr. Surg. 2003;12(4):241-253. doi:10.1053/j.sempedsurg.2003.08.005.

4. O’Neil M, Teitelbaum DH, Harris MB. Total body sodium depletion and poor weight gain in children and young adults with an ileostomy: a case series. Nutr. Clin. Pract. 2014;29(3):397-401. doi:10.1177/0884533614528543.

5. Al-Harbi K, Walton J., Gardner V, Chessell L, Fitzgerald P. Mucous fistula refeeding in neonates with short bowel syndrome. J. Pediatr. Surg. 1999;34(7):1100-1103. doi:10.1016/S0022-3468(99)90575-4.

6. Pena A, Migotto-Krieger M, Levitt M a. Colostomy in anorectal malformations: a procedure with serious but preventable complications. J. Pediatr. Surg. 2006;41(4):748- 56. doi:10.1016/j.jpedsurg.2005.12.021.

7. Ziegler MM. Meconium ileus. In: Pediatric Surgery. 7th ed. Elsevier; 2012:1073-1083. doi:10.1016/B978-0-323- 07255-7.00083-0.

8. De La Torre L, Langer JC. Transanal endorectal pull-through for Hirschsprung disease: technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms. Semin. Pediatr. Surg. 2010;19(2):96-106. doi:10.1053/j.sempedsurg. 2009.11.016.

9. Wong KKY, Lan LCL, Lin SCL, Chan AWS, Tam PKH. Mucous Fistula Refeeding in Premature Neonates With Enterostomies. J. Pediatr. Gastroenterol. Nutr. 2004;(July):43-45.

10. Andez ERN. Técnica extracorpórea de recirculación enteral en un prematuro con ileostomía proximal : a propósito de 1 caso. Enferm. clínica 2007;1776(6):326-330.

11. Pratap A, Kaur N, Shakya VC, et al. Triple tube therapy: a novel enteral feeding technique for short bowel syndrome in low-income countries. J. Pediatr. Surg. 2007;42(3):470-3. doi:10.1016/j.jpedsurg.2006.10.040.

12. Lévy E, Palmer DL, Frileux P, Parc R, Huguet C, Loygue J. Inhibition of upper gastrointestinal secretions by reinfusion of succus entericus into the distal small bowel. A clinical study of 30 patients with peritonitis and temporary enterostomy. Ann. Surg. 1983;198(5):596-600. doi:10.1097/00000658- 198311000-00006.

13. Lau EC, Fung AC, Wong KK, Tam PK. Beneficial effects of mucous fistula refeeding in necrotizing enterocolitis neonates with enterostomies. J. Pediatr. Surg. 2016:10-12. doi:10.1016/j.jpedsurg.2016.09.010.

14. K. Schäfer, Z. Zachariou, W. Löffler RD. Continuous extracorporeal stool-transport system : a new and economical procedure for transitory short-bowel syndrome in prematures and newborns. Pediatr. Surg. Int. 1997;12:73-75.

15. Bischoff A, Levitt M a, Peña A. Total colonic aganglionosis: a surgical challenge. How to avoid complications? Pediatr. Surg. Int. 2011;27(10):1047-52. doi:10.1007/s00383-011- 2960-y.

16. Sidebotham EL, Sepkowitz K, Price AP, Steinherz PG, La Quaglia MP, Kayton ML. Eradication of cryptosporidium from a defunctionalized colon limb by refeeding stoma effluent. J. Pediatr. Surg. 2010;45(1):E33-6. doi:10.1016/j. jpedsurg.2009.10.091.

17. Pataki I, Szabo J, Varga P, et al. Recycling of bowel content: the importance of the right timing. J. Pediatr. Surg. 2013;48(3):579-84. doi:10.1016/j.jpedsurg.2012.07.064.

18. Haddock CA, Stanger JD, Albersheim SG, Casey LM, Butterworth SA. Mucous fistula refeeding in neonates with enterostomies. J. Pediatr. Surg. 2015;50(5):779-782. doi:10.1016/j.jpedsurg.2015.02.041.

19. Richardson L, Banerjee S, Rabe H. What Is the Evidence on the Practice of Mucous Fistula Refeeding in Neonates With Short Bowel Syndrome? J. Pediatr. Gastroenterol. Nutrtion 2006;43:267-270.

20. Li S-TT, Grossman DC, Cummings P. Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis. PLoS Med. 2007;4(3):e98. doi:10.1371/ journal.pmed.0040098.