Laparoscopic localization and microlaparotomy for focal isolated perforation in necrotizing enterocolitis: an alternative approach to a challenging problem

Nah, Shireen Anne; Tan, Hock Lim; Tamba, Riana Pauline; Aziz, Dayang Anita Abdul; Azzam, Nurliza

doi:10.1016/j.jpedsurg.2010.11.045

Cited by 5 publications

(2 citation statements)

References 9 publications

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“…Despite the continuous improvement in the level of treatment, NEC remains a serious life-threatening gastrointestinal disease in premature infants and is accompanied by serious complications (10,11). Retrospective studies have shown that approximately 20-60% of preterm infants with NEC require surgery (12)(13)(14). Despite improvements in neonatal care, overall mortality (32%) for advanced NEC has not changed over the past 10 years (15).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Factors Influencing Outcomes in Preterm Infants With Necrotizing Enterocolitis

Han

Liu

et al. 2022

Front. Pediatr.

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BackgroundTo explore the surgical outcomes between patients with perforated and non-perforated neonatal necrotizing enterocolitis (NEC) and identify indications for surgical intervention.MethodsThe surgical outcomes of 271 children with NEC admitted to the Seventh Medical Center of Chinese PLA General Hospital between August 2009 and August 2020 were retrospectively analyzed. The patients were divided into the non-perforated and perforated groups. The preoperative factors, including gestational age, birth weight, intrauterine infection, cholestasis, platelet change, white blood cell count, and C-reactive protein level were compared between the two groups, along with postoperative factors including infection status, complications, enteral and parenteral nutrition time, ICU time, ventilator use time, and intestinal necrosis length. Bell staging was performed for the two groups and the mortality of different Bell stages was explored. The risk of death and predisposing factors of patients with NEC were analyzed.ResultsIn total, 271 children undergoing surgery were included in this study. A total of 188 children were observed without perforation, including 57 deaths (30.3%), and 83 children with perforation, including 24 deaths (28.9%). Preoperative cholestasis and time from NEC diagnosis to surgery were significantly different between the two groups (P < 0.05). Postoperative factors, including parenteral nutrition time (32 [3–94] days vs. 23 [1–53] days), enteral nutrition time (27 [0–86] days vs. 18 [0–81] days), NICU time (44 [5–125] days vs. 29 [1–92] days), and length of intestinal necrosis (15 [0–92] cm vs. 10 [2–70] cm), were significant. The mortality rate of patients with Bell stage IIIA was higher than that of patients with Bell stage IIIB. A total of 81 patients had 30-day postoperative mortality (57 non-perforated cases). Multivariate Cox regression analysis showed that non-perforation was a poor prognostic factor for survival outcome (hazard ratio 2.288, 95% confidence interval [1.329-3.940], P = 0.003).ConclusionsPreterm infants in the non-perforated group had more serious complications and had a longer recovery time after surgery. Bell staging is not accurate in diagnosing severe NEC that needs surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Analysis of Factors Influencing Outcomes in Preterm Infants With Necrotizing Enterocolitis

Han

Liu

et al. 2022

Front. Pediatr.

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“…Most of these options used to require an extensive transverse abdominal incision to thoroughly investigate the whole abdominal cavity. [ 5 ] Therefore, a wait and see approach was usually taken, which extended the fasting period and was not beneficial to their future neurodevelopment. On the other hand, diagnostic laparoscopy could reveal ascites as well as bowel perforation with an intra-umbilical incision with inconspicuous scar.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic laparoscopy for neonatal perforated Meckel′s diverticulum

et al. 2016

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Pneumoperitoneum in a neonate is a serious condition for which bowel perforation is indicated in most cases. Because the transdiaphragmatic air dissection could occur in some ventilated neonates without peritonitis, making the right diagnosis is sometimes difficult, and exploratory laparotomy is often necessary. Here, we report the first case of neonatal pneumoperitoneum caused by a perforated Meckel's diverticulum in which diagnostic laparoscopy was useful in achieving minimal access surgery. Using a multiuse single-site port on the umbilicus could enable the extraction of a certain length of a small intestine with good cosmetic results. This method would decrease the hurdles of early surgical interventions for the suspected perforation of unknown aetiology and shorten the fasting period, which is beneficial for the neurodevelopment of small neonates.

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Early laparoscopic-assisted surgery is associated with decreased post-operative inflammation and intestinal strictures in infants with necrotizing enterocolitis

Montalva

Incerti

Qoshe

et al. 2023

Journal of Pediatric Surgery

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Laparoscopic localization and microlaparotomy for focal isolated perforation in necrotizing enterocolitis: an alternative approach to a challenging problem

Cited by 5 publications

References 9 publications

Analysis of Factors Influencing Outcomes in Preterm Infants With Necrotizing Enterocolitis

Analysis of Factors Influencing Outcomes in Preterm Infants With Necrotizing Enterocolitis

Diagnostic laparoscopy for neonatal perforated Meckel′s diverticulum

Early laparoscopic-assisted surgery is associated with decreased post-operative inflammation and intestinal strictures in infants with necrotizing enterocolitis

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