Feasibility of extremely short distal and ileocecostomy in infants

Objective To explore the feasibility of ileocecal valve-preservation ileocecostomy (IVPI) for infants with an extremely short distal ileal stump after primary single side ileostoma. Methods A retrospective analysis was performed for 11 IVPI cases from 2014 to 2017. There were 7 boys and 4 girls. The causes were neonatal necrotizing enterocolitis (NEC) (n=8, length of residual small intestine <60 cm in 2) and ileocecal atresia (n=3, torsional necrosis of blind end in 1). All children underwent primary distal single side ileostoma. The average operative closure age was 6 (3-8) months, the average body weight 5.4 (2.3-6.5) kg and the average pre-anastomotic residual length of small intestine 90 (50-140) cm. Among them, the residual length was <60 cm in two cases. The distance from distal ileal stoma to ileocecal valve had a range of 0-0.5 cm. The relevant clinical data included age, weight, length of ileal stump, surgical technique, complications and short/medium-term follow-ups. Results IVPI was successfully performed in all patients without anastomotic leakage or stenosis. Ileocecal valve plasty was performed due to ileocecal valve atresia or stenosis (n=3). Seven cases were uneventful postoperatively whereas wound infection (n=3) and acquired sepsis (n=1) caused a delayed recovery. During a follow-up period of 5-36 months, there was no onset of bowel obstruction, malnutrition, chronic diarrhea or other late complications. Body height and weight were all normal. Conclusions IVPI is both safe and feasible for infants with an extremely short distal ileal stump. Key words: Ileocecal valve; Anastomosis, surgical; Infants