Outcomes of neonates undergoing emergency laparotomy with stoma formation

Abstract Background Stomas are commonly formed in neonatal emergency laparotomy when primary anastomosis is deemed unsafe. This study reviews its indications, technical approaches and outcomes. Methods A retrospective review (July 2019 – March 2025) of neonates undergoing emergency laparotomy at a Hong Kong tertiary paediatric surgical centre was conducted. Results Among 178 laparotomies, 77 (43.3%) required stomas, with mean gestational age of 31 weeks, age at surgery 17 days old and body weight at surgery 1.9 kg. Necrotizing enterocolitis (NEC) was the leading indication (41.6%). Double‐barrel stomas were most frequent (75.3%), with other configurations including Bishop‐Koop and multiple stoma pairs. Stomas were sited through‐wound (67.5%) or via a separate wound (32.5%). Overall stoma complication rate was 40.2%. Necrotizing enterocolitis (OR 6.05, p = .002) and through‐wound stoma siting (OR 4.29, p = .03) were risk factors, with NEC associated with stoma stenosis ( p = .003) and retraction ( p = .03) while through‐wound siting with wound dehiscence ( p = .02). Elective stoma closure rate was 84.4% at a mean of 61.7 days post‐formation with body weight 3.3 kg. Conclusion Stoma‐related complications are common in neonates, particularly with NEC, but are often managed non‐operatively. Surgical approaches also influence the risk. Prospective multi‐institutional studies are needed to validate risk factors for outcome improvement.