WOFAPS 2025 8th World Congress of Pediatric Surgery

Sidra Rauf ¹, Adinda Pijpers ², Ingo Jester ¹, Ramon Gorter ²

¹ Birmingham Children's Hospital
² Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Amsterdam, the Netherlands

Aim:

The optimal treatment strategy for simple meconium ileus (SMI) after gastrografin enema failure remains the subject of debate. Therefore, this systematic review aims to aggregate the available literature of neonates with SMI and compare the number of redo surgeries and complication rates between patients who received enterostomy formation (ES) versus enterotomy with irrigation (EI).

Methods:

In November 2024, a search was performed in PubMed. Studies describing surgical strategy with ES or EI in patients with SMI were considered eligible. The primary outcomes were LOS, redo surgeries and complication rates.

Results:

In total, nine studies were considered eligible, representing 199 patients with SMI. Of those patients, 108 had ES and 34 were treated with EI; the remaining 57 patients were not eligible. Of the 108 patients treated with ES, seven received a redo surgery. In nine patients, an anastomotic leakage was reported. Ten patients developed sepsis, with four resulting in death. Nine patients suffered stoma-related issues such as high output, prolapse, and necrosis. Only one adhesiolysis was reported. Of the 34 patients treated with EI, complications were reported in one of the four studies. One patient developed postoperative ileus, and one patient had adhesional bowel obstruction. No redo surgeries were reported.

Conclusion: Due to the paucity of direct comparative studies, it is difficult to comment on the superiority of EI over ES in SMI. However, our data shows that EI has merit, with a low complication/no re-laparotomy rate. A prospective randomised controlled trial should be undertaken.