The Timing of Stoma Closure in Infants with Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis

Aim Some infants with necrotizing enterocolitis (NEC) undergoing surgery require the formation of a stoma. The timing of stoma closure in these patients remains controversial. Our aim was to determine whether the different timing of closure had an impact on patient outcome. Methods Using a defined search strategy (PubMed, Embase, and Web of Science), two investigators (Q.L. and G.L.) independently identified studies comparing early stoma closure (ESC, before 8 weeks from stoma formation) versus late stoma closure (LSC, after 8 weeks) in infants with NEC. Outcome measures included the duration of parenteral nutrition, the length of hospital stay, and complications. Meta-analysis was performed using RevMan 5.3 (The Cochrane Collaboration, Copenhagen, Denmark). Data are expressed as mean ± standard deviation. Results of the 505 articles screened, 6 articles met the inclusion criteria (280 infants). All studies but one were retrospective. The total duration on parenteral nutrition was similar in infants with ESC versus LSC, and the total length of hospital stay (pre- plus poststoma closure) was not influenced by the timing of stoma closure. Three studies (79 infants) reported similar complication rates after stoma closure between ESC (5/16, 31%) and LSC infants (13/63, 19%; p = 0.5). Conclusions This systematic review demonstrates that there is no difference between different timings for stoma closure in post-NEC infants. With the current supporting evidence, ESC seems to be as safe and feasible as LSC. Studies with a higher level of evidence are needed to confirm these conclusions.