APPLICATIONS OF TUBE STOMAS IN THE PAEDIATRIC SURGICAL POPULATION

Formation of a tube stoma comprises purse-string suture of bowel around a catheter. The bowel is secured to the abdominal wall, and the catheter brought out through the fascia. This technique has been described in the management of short bowel syndrome. It reduces the length of bowel required to form stomas, diverts the proximal enzyme-rich effluent away from the skin and enables controlled dilatation of the proximal bowel for future surgical reconstruction. We aimed to investigate whether such stomas might be effective in managing other groups of patients requiring proximal stoma formation. Three neonates with proximal jejunal atresia underwent formation of tube jejunostomy at initial laparotomy. Size discrepancy between the proximal dilated bowel and distal atretic segment precluded primary anastomosis and would have increased the risk of prolapse in a spouted stoma. Additional considerations were preservation of residual bowel length and protection of skin. The procedures were well tolerated. No skin excoriation was evident and proximal effluent was successfully recycled distally. This permitted enteral feeding, thus avoiding prolonged parenteral nutrition, promoting bowel adaptation and reducing risk of infection. Tube stoma intervention can be extended to other paediatric surgical conditions, in which it facilitates progression to enteral feeding and prevents complications.