DOI
https://doi.org/10.47689/2181-3663-vol4-iss3-pp1-14Keywords
children , ileostomy , stoma complications , surgical outcomes , rehabilitation program , postoperative care , reconstructive surgeryAbstract
Objective. To evaluate and compare various tactical approaches in managing children with ileostomies, with particular focus on assessing the effectiveness of a comprehensive rehabilitation program in reducing postoperative complications, optimizing recovery, and improving long-term outcomes.
Methods. A total of 126 pediatric patients with ileostomies, treated between 2014 and 2024, were included. The comparison group (n=71) consisted of children managed during 2014–2019 with conventional approaches, while the main group (n=55) included patients treated from 2020 onwards with an optimized rehabilitation protocol. This protocol comprised structured parent and patient education, individualized stoma care, use of antiseptic combinations, application of protective films, creams, and absorbent dressings, as well as adjuvant low-intensity laser therapy. Rational nutritional support was also provided. Outcomes analyzed included early and late stoma-related complications, systemic postoperative morbidity, duration of hospitalization, and frequency of reconstructive operations. Statistical analysis employed χ² tests and Student’s t-test, with significance set at p<0.05.
Results. Early stoma-related complications occurred in 53.5% of the comparison group versus 27.3% of the main group (p=0.003). Systemic postoperative complications were reduced from 46.5% in the comparison group to 25.5% in the main group (p=0.016). According to the Clavien–Dindo classification, severe (grade III-V) complications were more frequent in the comparison group (49.3% vs. 14.6%, p=0.002). The rate of late stoma complications decreased from 40.0% to 19.2% (p=0.017), and peristomal skin complications from 41.7% to 21.2% (p=0.015). The mean postoperative hospital stay was significantly shorter in the main group (11.5±0.35 vs. 13.2±0.5 days, p<0.001). Moreover, a higher proportion of patients in the main group underwent timely reconstructive procedures, while persistent functioning stomas were more frequent in the comparison group (16.7% vs. 3.8%).
Conclusion. The implementation of a comprehensive rehabilitation strategy, incorporating advanced local and systemic management techniques, significantly reduced complication rates, improved microbiota restoration, shortened hospitalization, and enhanced surgical rehabilitation outcomes in children with ileostomies.
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