Intestinal stoma prolapse and surgical treatments of this condition in children

Prince Johnson, Student, MD. Facullty of medicine university of Oslo

Background: An intestinal stoma is a surgical opening of the intestine, mostly sutured to the anterior abdominal wall. It is a common lifesaving operative procedure done on children. Stoma prolapse is one of the common complications of stoma. A significant number of stoma prolapse patients require surgical correction.

Aim: This thesis is in two parts. The first part is a literature review of intestinal stoma prolapse and its surgical treatments. The second part is an evaluation of the effect of surgical treatments of this condition on children at OUS-R.

Methods: Literature-A literature search using the PubMed and Google scholar database was performed. Studies included randomized clinical trials, observational studies, letters, editorials and review articles. Sixty-three English-language studies were selected for the literature review.
Patients evaluation: Design, Setting, and Participants – A retrospective review of pediatric patients (< 13 years) surgically treated for intestinal stoma prolapse at OUS-R from 2001 to 2013.

Results: Literature-Most published incidence of intestinal stoma prolapse for children varies from 8.1% to 25.6%, median 18.8%. Many proposed surgical repair procedures for stoma prolapse are available; and varies from being ineffective to 100% effective.

Results: Patients evaluation at OUS-R-From 2001 to 2013, 14 of the 304 children with stoma (4.6%), experienced stoma prolapse. Five of these 14 stomas were considered appropriate for closure, and 9 stoma prolapse were surgically corrected: Five of the 9 patients with stoma prolapse were initially diagnosed with Mb Hirschsprung. Median age at stoma formation for the 9 patients was 1.7 years. Surgical procedures and success rate: Median 2, range 1-9 operations/person; varies from being ineffective to 50% effective.

Conclusion: Findings from the literature review and the study at OUS-R suggest that, stoma prolapse repair is a surgical challenge. Thus, preferably when possible, closure of the stoma would be most suitable. Neither the extra-abdominal nor the intra-abdominal surgical methods have been proven superior to one another (in large studies). More research and larger potential studies would be required. An intra-abdominal surgical procedure which best addresses intestinal fixation, may be the best surgical repair method for sliding stoma prolapse. Incidence of stoma prolapse in our series of pediatric patients at OUS-R is lower than most (if not all) published incidence in the pediatric medical literature.