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The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review.

Struijs MC, Sloots CE, Hop WC, Tibboel D, Wijnen RM - Pediatr. Surg. Int. (2012)

Bottom Line: One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027).EC) was 1.1 [95% CI 0.5, 2.5].There is no significant difference between EC versus LC in the complication rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands.

ABSTRACT

Purpose: The optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necrotizing enterocolitis.

Methods: PubMed, EMbase, Web-of-Science, and Cinahl were searched for studies that detailed time to ostomy closure, and time to full enteral nutrition (FEN) or complications after ostomy closure. Patients with Hirschsprung's disease or anorectal malformations were excluded. Analysis was performed using SPSS 17 and RevMan 5.

Results: Of 778 retrieved articles, 5 met the inclusion criteria. The median score for study quality was 9 [range 8-14 on a scale of 0 to 32 points (Downs and Black, J Epidemiol Community Health 52:377-384, 1998)]. One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027). Four studies reported complication rates after ostomy closure, complications occurred in 27% of the EC group versus 23% of the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95% CI 0.5, 2.5].

Conclusion: Evidence that supports early or late closure is scarce and the published articles are of poor quality. There is no significant difference between EC versus LC in the complication rate. This systematic review supports neither early nor late ostomy closure.

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Forest plot comparison of postoperative complications in EC versus LC
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Fig2: Forest plot comparison of postoperative complications in EC versus LC

Mentions: Weber et al. [13] only analyzed EC, and found a complication rate of 39 % (Table 2); therefore, this study could not be used in the meta-analysis. The other three studies could be used for meta-analysis in the forest plot (Fig. 2). Combining all three studies, the complication rate did not differ greatly between both groups, 27 % (15/55) in the EC group versus 23 % (16/69) in the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95 % CI 0.5, 2.5].Table 2


The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review.

Struijs MC, Sloots CE, Hop WC, Tibboel D, Wijnen RM - Pediatr. Surg. Int. (2012)

Forest plot comparison of postoperative complications in EC versus LC
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3376257&req=5

Fig2: Forest plot comparison of postoperative complications in EC versus LC
Mentions: Weber et al. [13] only analyzed EC, and found a complication rate of 39 % (Table 2); therefore, this study could not be used in the meta-analysis. The other three studies could be used for meta-analysis in the forest plot (Fig. 2). Combining all three studies, the complication rate did not differ greatly between both groups, 27 % (15/55) in the EC group versus 23 % (16/69) in the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95 % CI 0.5, 2.5].Table 2

Bottom Line: One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027).EC) was 1.1 [95% CI 0.5, 2.5].There is no significant difference between EC versus LC in the complication rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia, Rotterdam, The Netherlands.

ABSTRACT

Purpose: The optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necrotizing enterocolitis.

Methods: PubMed, EMbase, Web-of-Science, and Cinahl were searched for studies that detailed time to ostomy closure, and time to full enteral nutrition (FEN) or complications after ostomy closure. Patients with Hirschsprung's disease or anorectal malformations were excluded. Analysis was performed using SPSS 17 and RevMan 5.

Results: Of 778 retrieved articles, 5 met the inclusion criteria. The median score for study quality was 9 [range 8-14 on a scale of 0 to 32 points (Downs and Black, J Epidemiol Community Health 52:377-384, 1998)]. One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027). Four studies reported complication rates after ostomy closure, complications occurred in 27% of the EC group versus 23% of the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95% CI 0.5, 2.5].

Conclusion: Evidence that supports early or late closure is scarce and the published articles are of poor quality. There is no significant difference between EC versus LC in the complication rate. This systematic review supports neither early nor late ostomy closure.

Show MeSH
Related in: MedlinePlus