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. 2012 Jul;28(7):667-72.
doi: 10.1007/s00383-012-3091-9. Epub 2012 Apr 21.

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

Marie-Chantal Struijs  1 , Cornelius E J Sloots, Wim C J Hop, Dick Tibboel, Rene M H Wijnen
Affiliations

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

Marie-Chantal Struijs et al. Pediatr Surg Int. 2012 Jul.

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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Figures

Fig. 1
Fig. 1
PRISMA flow chart presenting the selection of studies
Fig. 2
Fig. 2
Forest plot comparison of postoperative complications in EC versus LC
See this image and copyright information in PMC

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