The feasibility of routine use of distal stoma refeeding method in newborns with enterostomy.

Objective: Temporary enterostomies are life-saving in neonatal surgery, however, causing loss of fluid electrolyte, delays in distal bowel adaptation and thus delayed growth of newborns. In this study, we aimed to present the method and clinical results of distal stoma refeeding in premature and mature neonates.Methods: Between January 2012 and December 2017, records of newborn patients who underwent enterostomy and distal stoma refeeding were retrospectively analyzed. Premature and full term neonates who had distal stoma refeeding were evaluated by stoma indications, resection status, duration of total parenteral nutrition use, time of stoma closure operation and surgery findings.Results: Distal stoma refeeding was performed to 23 newborns in study period. Surgical diagnosis of newborns were meconium ileus, focal intestinal perforation, volvulus, necrotizing enterocolitis, ileal atresia, jejunal atresia, and gastroschisis. The bowel resection was performed in 14 patients. Stoma closure was done on the average day 77th. Total parenteral nutrition was given average 28 d and no total parenteral nutrition complication was seen. The stoma closure operations were performed easily.Conclusions: Distal stoma refeeding is safe and successful method. The success of distal stoma refeeding depends on expert team, time, and equipment.

Treatment of Congenital Gastric Outlet Obstruction due to a Web: A Retrospective Single-center Review.

BACKGROUND: Congenital gastric antral web and congenital pyloric atresia are rare reasons of congenital gastric outlet obstruction (CGOO). Depending on the different forms, the symptoms vary from unspecific epigastric pain to nonbilious "projectile" vomiting, ileus and failure to thrive. Throughout the years, many different treatment options are described, like simple surgical dilatation, incision or excision of the membrane, possibly combined with a pyloroplasty. PATIENTS AND METHODS: In this retrospective single-center observation study, we present 9 cases with different kinds of webs leading to CGOO. In a time period of 45 years (1970 to 2015) different treatment strategies and limitations of minimal invasive endoscopic treatment on the basis of complications and outcome are discussed. RESULTS: Six patients had an incomplete antrum web. One patient suffered from a complete antrum web. In addition, in 2 patients a complete pyloric web, as well as an incomplete pyloric web was found. During the past 45 years, the treatment options for CGOO due to webs changed, and with the development of smaller and more flexible video endoscopes an endoscopic treatment has become feasible. The treatment strategy and follow-up examination was specific to every patient. CONCLUSION: On the basis of our review, minimal endoscopic procedures in small newborns and toddlers require a high level of experience. They are technically challenging and need suitable equipment. Overall, endoscopists and pediatric surgeons should equally be prepared for all possible complications in every treatment step. The endoscopic approach to managing this unusual disease may require multiple interventions and is associated with a risk of perforation. Therefore, we are convinced that centers undertaking this treatment modality should be equipped with the proper instrumentation, prepared to perform multiple endoscopic interventions, and supported with an ability to emergently convert to surgery if required.

Duodenal histology for monitoring treatment of acute rejection in pancreaticoduodenal allografts in rats.

BACKGROUND: Although the value of duodenal histology as a means to diagnose acute rejection in pancreaticoduodenal allografts has been validated, it is not known how the duodenum responds to antirejection treatment in comparison with the pancreas. METHODS: Diabetic Lewis rats received a pancreaticoduodenal allograft. Cyclosporine was given for 5 days and then discontinued for 2 days (group 1), for 4 days (group 2), for 6 days (group 3), for 8 days (group 4), for 9 days (group 5), and for 10 days (group 6). Two animals of each group were killed for histology at the end of immunosuppressive-free intervals. In the remaining rats, rejection was treated with methylprednisolone on 3 consecutive days. Duodenal histology was compared with pancreatic morphology before and after treatment of rejection. RESULTS: Duodenal histology had a positive and negative predictive value of 100% for detection of acute rejection in the pancreatic portion of the graft. After antirejection treatment, duodenal morphology was however less accurate (positive predictive value, 96%; negative predictive value, 67%). The Spearman correlation coefficient (p) of duodenal and pancreatic rejection grades was higher before antirejection treatment (p=1.0) than thereafter (p=0.724). Considering interstitial and vascular changes separately, vascular rejection correlated to a higher extent than interstitial rejection between the two portions of the graft (p=0.725 vs. p=0.677). CONCLUSIONS: Duodenal histology accurately predicts the initial diagnosis of rejection of the pancreas. However, after treatment of acute rejection, duodenal morphology is more likely to recover from rejection than the pancreas. Awareness of this phenomenon might be important for the interpretation of duodenal follow-up biopsies.