Ileocecal valve-preservation ileocecostomy (IVPI) in infants with extremely short distal ileum after primary stoma
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In brief
In brief
This retrospective study demonstrates that ileocecal valve-preservation ileocecostomy is a safe surgical technique for infants with extremely short distal ileum following primary ileostomy. All 18 patients, primarily with necrotizing enterocolitis, achieved normal growth with preserved ileocecal valve function during follow-up.
- Ileocecal valve preservation is feasible even with distal ileal stumps as short as 0.5-2 cm in infants after primary ileostomy.
- IVPI allows enteral feeding resumption within 6-11 days with low complication rates in high-risk neonates (median birth weight 1305g).
- ICV-plasty can salvage cases with secondary ileocecal valve occlusion or stenosis, maintaining valve function.
- All 18 infants demonstrated normal growth and development at 6-65 month follow-up despite extremely short bowel anatomy.
- Primary indications included NEC (72%), with median stoma closure at 3.2 months corrected age and residual bowel length 50-130 cm.
Written by the GCMD Library team from the article.
Abstract
Purpose
Preserving the ileocecal valve (ICV) has shown significant benefits. We present our experience with 18 infants who underwent ileocecal valve-preservation ileocecostomy (IVPI) with an extremely short distal ileum after primary ileostomy.
Methods
A retrospective analysis was conducted on IVPI cases between 2014 and 2020. Medical records were reviewed, including birth weight, age, primary diseases, length of ileus stump, surgical time and procedure, time to enteral feeding, postoperative hospital stay, and complications.
Results
Eighteen patients (male: female = 12:6, median birth weight 1305 (750–4000) g, median gestational age 29 + 5 (27 + 6–39 + 6) weeks) were included in the analysis. Causes of surgery included necrotizing enterocolitis (13), ileocecal intestinal atresia (1), ileum volvulus (2), meconium peritonitis (1), and secondary intestinal fistula (1). The median corrected age of ileostomy closure was 3.2 months (2.0–8.0 months). The distance from the distal ileal stoma to the ICV ranged from 0.5 to 2 cm. The median length of the residual bowel was 90 cm (50–130 cm). ICV-plasty was performed in 3 cases due to secondary ICV occlusion or stenosis. All patients resumed feeding within 6 to 11 days after surgery. The postoperative hospital stay ranged from 12 to 108 days (median: 16.5 days). Complications included incisional infections in 2 cases, anastomotic stricture and adhesive ileus in 1 case, nosocomial sepsis and septic shock in 1 case. All children showed normal growth and development during a 6–65 month follow-up.
Conclusions
IVPI is safe and feasible for infants with an extremely short distal ileal stump. ICV-plasty could be applicable for cases with ileocecal occlusion/stenosis.