The safety and effectiveness of Santulli enterostomy in neonatal intestinal conditions

Abstract

BackgroundAs an end stoma, Santulli enterostomy provides early restoration of intestinal continuity without formal laparotomy. Short amputation of the common limb enables closure on a side to restore anatomic continuity without sacrificing valuable intestine; additionally, the procedure is simple and safe. Most newborns who require enterostomy might benefit from Santulli enterostomy; however, several pediatric surgeons lack information regarding this procedure. Therefore, we have reviewed our experience about Santulli enterostomy and explore the advantages and indications in neonatal intestinal conditions.MethodsThe clinical data of 76 neonates who underwent enterostomywere obtained. The patients were divided into two groups: the Santulli group with 33 cases who underwent Santulli enterostomy, and the control group with 43 cases who underwent double- or single-lumen ostomy. The general data of the two groups were analyzed, and the perioperative/postoperative complications, clinical data and the long-term outcomes were compared.ResultsThere was no difference in the demographic informations, the level of enterostomy, the rate of high-sight stoma, the operative time and bleeding of enterostomy between the two groups. Compared to the control group, the operative time of ostomy closure was less in the Santulli group (53.00 vs. 152.47, P < 0.001). The duration of parenteral nutrition (27.45 vs. 44.56, P = 0.010), the mean interval of initial enterostomy to stomal closure (131.21 vs. 216.42, P < 0.001), and length of stay (46.00 vs. 67.60, P = 0.007) were shorter, while the incidence of postoperative complications and hospitalization costs (11.21 vs. 15.49, P = 0.006) were lower. The Santulli procedure can reduce the morbidity of high output ostomy (2 vs. 10, P = 0.042) and short bowel syndrome (3 vs. 132, P = 0.025), shorten the discrepancy of diameter between the proximal and distal segments, maximize the available intestine, and monitor the movement of the distal bowel. The length of incision was shorter, and the catch-up growth was significantly faster in the Santulli group.ConclusionSantulli enterostomy is a superior procedure in the treatment of neonatal intestinal conditions, in terms of fewer complications, faster catch-up growth, shorter hospitalization time and treatment duration. It should be the procedure of choice in several newborns with intestinal conditions that require ostomy.

A comparative evaluation between Santulli-Type Ileostomy and Alternative Ileostomy Techniques in neonates

“…Demographic profiles exhibited similarities, with no specific criteria dictating the choice of ileostomy creation technique, aside from surgeon preference. Intestinal atresia was the most prevalent congenital pathology, while necrotizing enterocolitis held a predominant position in the acquired spectrum, consistent with Yue M et al (1). At present, the literature favors Santulli-type ileostomies, allowing for partial diversion of intestinal content.…”

“…The Santulli-type ileostomy has emerged as a prominent approach, presenting substantial advantages (1). This surgical technique involves exposing the proximal intestine through the abdominal wall and performing an end-to-side anastomosis with the distal intestine, typically around 5cm away on the antimesenteric side (Figure 1).…”

“…In the Santulli-type ileostomy group, interval stoma occlusions were performed to encourage rectal defecation (1).…”

Systematic review on management of high‐output enterostomy in children: An urgent call for evidence

“…If deemed feasible based on the patient's clinical condition, underlying pathology, and anatomy, the enterostomy could be closed earlier than initially planned to avoid further clinical deterioration and adverse events as a consequence from the high‐out enterostomy 5,7 . However, restoring the enteral continuity is not always possible due to underlying pathology, such as total aganglionosis (from the colon) or paediatric intestinal pseudo‐obstruction syndrome requiring alternatives such as autologous intestinal reconstructive surgery or other reconstructive procedures 50–53 …”

“…5,7 However, restoring the enteral continuity is not always possible due to underlying pathology, such as total aganglionosis (from the colon) or paediatric intestinal pseudo-obstruction syndrome requiring alternatives such as autologous intestinal reconstructive surgery or other reconstructive procedures. [50][51][52][53] An observational multicenter study evaluated the value of autologous reconstructive surgery among eight children with (near) total intestinal aganglionosis, complicated by persistent high-output jejunostomy and failure to thrive. 54 Here, a high-output enterostomy was defined as daily enteric fluid loss of >20 mL/kg associated with poor weight gain and urine sodium level <10 mmol/L.…”