Intestinal Anastomosis During Enterostomy Takedown Using a 5 mm Miniature Endostapler Compared to Conventional Handsewn Technique.

Abstract

Aim: Enterostomy takedown is common in neonates with Hirschsprung's disease, anorectal malformations, or necrotizing enterocolitis. Stapled bowel anastomosis has become routine in adults, but size of up to 12 mm diameter precludes performing enterostomy takedown in young infants using regular intestinal staplers. After the introduction of miniature (5 mm diameter) staplers, we increasingly used them for enterostomy takedown. This study compares enterostomy takedown using the miniature stapler (MS) to the conventional hand-sewn (HS) technique.

Methods: Retrospective review of all children <3 years of age undergoing enterostomy closure at our institution from 2008 to 2023 were retrospectively reviewed. Demographics, operative times, complications, and outcomes were compared between those who underwent the procedure using MS versus HS technique. Data are quoted as median (range).

Results: A total of 102 patients were enrolled, including MS (n = 26) and HS (n = 76) anastomoses. There were no statistical differences in age, sex, or indication for enterostomy. Enterostomy takedown using MS was faster [82.5 (44-218) versus 147 (52-381) minutes, p < 0.001) and associated with earlier commencement of feedings [2 (1-6) versus 4 (1-24) days, p = 0.001], as well as shorter length-of-stay [6 (2-20) versus 17 (3-52) days, p < 0.001), compared to the HS technique.

Conclusions: This is the first study that systematically evaluates the novel 5 mm ministapler for enterostomy takedown in young children. Its use was associated with quicker operative times, earlier feeding and shorter hospital stay. These findings are especially relevant in children with co-morbidities who do not tolerate longer anesthesia times. Randomized, controlled trials should be performed to prospectively confirm these findings.

Level of evidence: Level III, retrospective comparative study.