Late Abdominal Reoperations after Surgery for Necrotizing Enterocolitis and Spontaneous Intestinal Perforation

Koivusalo, Antti; Karila, Kristiina; Pakarinen, Mikko P.

doi:10.1055/s-0040-1722616

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…Some doctors advocate enteroplasty, and late abdominal resurgery was performed after necrotizing enterocolitis and spontaneous bowel perforation. Late abdominal reoperations occurred in 15% of patients with NEC with nil mortality [ 157 ].…”

Section: Treatment Of Necmentioning

confidence: 99%

Necrotizing enterocolitis: current understanding of the prevention and management

Hu,

Liang,

et al. 2024

Pediatr Surg Int

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Necrotizing enterocolitis (NEC) is one of the diseases in neonates, with a high morbidity and mortality rate, especially in preterm infants. This review aimed to briefly introduce the latest epidemiology, susceptibility factors, and clinical diagnosis and presentation of NEC. We also organized new prevention strategies by risk factors according to different pathogeneses and then discussed new treatment methods based on Bell's staging and complications, and the classification of mild to high severity based on clinical and imaging manifestations. Such a generalization will help clinicians and researchers to gain a deeper understanding of the disease and to conduct more targeted classification, grading prevention, and exploration. We focused on prevention and treatment of the early and suspected stages of NEC, including the discovery of novel biomarkers and drugs to control disease progression. At the same time, we discussed its clinical application, future development, and shortcomings.

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Section: Treatment Of Necmentioning

confidence: 99%

Necrotizing enterocolitis: current understanding of the prevention and management

Hu,

Liang,

et al. 2024

Pediatr Surg Int

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“…Due to the rapid progress of NEC, 30–50% of pediatric patients need surgical intervention ( 17 ). NEC intestinal perforation is the absolute indication of surgical treatment, but the surgical indication and timing of children without intestinal perforation are still controversial ( 18 ). Thus, a means for doctors to accurately identify the indications of NEC surgery in a timely fashion and choose the best operation opportunity is urgently needed to improve the prognosis of pediatric patients to the greatest extent.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of serum markers in the operation evaluation of neonatal necrotizing enterocolitis

Wang¹,

Jin²,

Su³

et al. 2023

Transl Pediatr

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Background Neonatal necrotizing enterocolitis (NEC) is a common gastrointestinal emergency in newborns. Currently, the pathogenesis of the disease remains unknown. This study aims to determine the application value of serum markers in the selection of operation opportunities for NEC. Methods This study consisted of a retrospective analysis of the clinical data of 150 participants with NEC admitted to Maternal and Child Health Hospital of Hubei Province from March 2017 to March 2022. Participants were assigned to an operation group (n=58) and a nonoperation group (n=92) according to the presence or absence of surgical treatment. Serum sample data for serum C-reactive protein (CRP) and interleukin 6 (IL-6), serum amyloid A (SAA), procalcitonin (PCT), and intestinal fatty acid-binding protein (I-FABP) concentrations were estimated. To compare the differences in overall data and serum markers between the 2 groups, independent factors related to surgical treatment in pediatric patients with NEC were analyzed using logistic regression. The utility of serum markers in selecting surgical options in pediatric patients with NEC was analyzed by constructing a receiver operating characteristic (ROC) curve. Results CRP, I-FABP, IL-6, PCT, and SAA levels were higher in the operation group than in the nonoperation group (P<0.05). Multivariate logistic regression analysis confirmed that CRP, I-FABP, IL-6, PCT, and SAA were independent related factors of NEC surgical remedy (P<0.05). Meanwhile, ROC curve analysis yielded a serum CRP, PCT, IL-6, I-FABP, and SAA area under curve (AUC) of NEC operation timing of 0.805, 0.844, 0.635, 0.872, and 0.864, respectively; a sensitivity of 75.90%, 86.20%, 60.30%, 82.80%, and 84.50%, respectively; and a specificity of 80.40%, 79.30%, 68.35%, 80.40%, and 80.55%, respectively. Conclusions The serum markers CRP, PCT, IL-6, I-FABP, and SAA have certain guiding values in the choice of operation opportunity for pediatric patients with NEC.

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“…In neonates with spontaneous intestinal perforation, the duration of parenteral nutrition showed a significant effect on developing SBO later in life. However, a causal relationship was not confirmed by the authors but was considered to reflect the initial severity of the bowel disease ( 56 ). Regarding postoperative nutrition, neither the type nor the timing of postoperative oral feeding revealed a correlation with SBO in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Small Bowel Obstruction After Neonatal Repair of Congenital Diaphragmatic Hernia—Incidence and Risk-Factors Identified in a Large Longitudinal Cohort-Study

et al. 2022

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ObjectiveIn patients with a congenital diaphragmatic hernia (CDH), postoperative small bowel obstruction (SBO) is a life-threatening event. Literature reports an incidence of SBO of 20% and an association with patch repair and ECMO treatment. Adhesions develop due to peritoneal damage and underly various biochemical and cellular processes. This longitudinal cohort study is aimed at identifying the incidence of SBO and the risk factors of surgical, pre-, and postoperative treatment.MethodsWe evaluated all consecutive CDH survivors born between January 2009 and December 2017 participating in our prospective long-term follow-up program with a standardized protocol.ResultsA total of 337 patients were included, with a median follow-up of 4 years. SBO with various underlying causes was observed in 38 patients (11.3%) and significantly more often after open surgery (OS). The majority of SBOs required surgical intervention (92%). Adhesive SBO (ASBO) was detected as the leading cause in 17 of 28 patients, in whom surgical reports were available. Duration of chest tube insertion [odds ratio (OR) 1.22; 95% CI 1.01–1.46, p = 0.04] was identified as an independent predictor for ASBO in multivariate analysis. Beyond the cut-off value of 16 days, the incidence of serous effusion and chylothorax was higher in patients with ASBO (ASBO/non-SBO: 2/10 vs. 3/139 serous effusion, p = 0.04; 2/10 vs. 13/139 chylothorax, p = 0.27). Type of diaphragmatic reconstruction, abdominal wall closure, or ECMO treatment showed no significant association with ASBO. A protective effect of one or more re-operations has been detected (RR 0.16; 95% CI 0.02–1.17; p = 0.049).ConclusionThoracoscopic CDH repair significantly lowers the risk of SBO; however, not every patient is suitable for this approach. GoreTex®-patches do not seem to affect the development of ASBO, while median laparotomy might be more favorable than a subcostal incision. Neonates produce more proinflammatory cytokines and have a reduced anti-inflammatory capacity, which may contribute to the higher incidence of ASBO in patients with a longer duration of chest tube insertion, serous effusion, chylothorax, and to the protective effect of re-operations. In the future, novel therapeutic strategies based on a better understanding of the biochemical and cellular processes involved in the pathophysiology of adhesion formation might contribute to a reduction of peritoneal adhesions and their associated morbidity and mortality.

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Late Abdominal Reoperations after Surgery for Necrotizing Enterocolitis and Spontaneous Intestinal Perforation

Cited by 4 publications

References 14 publications

Necrotizing enterocolitis: current understanding of the prevention and management

Necrotizing enterocolitis: current understanding of the prevention and management

Predictive value of serum markers in the operation evaluation of neonatal necrotizing enterocolitis

Small Bowel Obstruction After Neonatal Repair of Congenital Diaphragmatic Hernia—Incidence and Risk-Factors Identified in a Large Longitudinal Cohort-Study

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