Publication:


abstract

INTRODUCTION:

The indication of surgery in necrotizing enterocolitis (NEC) can be difficult in the absence of pneumoperitoneum or peritonitis. We propose laparoscopy for early diagnosis of intestinal perforation or necrosis in order to avoid unneccessary laparotomies.

MATERIAL AND METHODS:

A new protocol was proposed which included diagnostic and therapeutic laparoscopy in cases of uncertain surgical ECN indication. Subsequently, a prospective study of the 7 patients who underwent laparoscopy was performed, analyzing pathophysiological effects in the premature, technical difficulties of the procedure, and postoperative diagnostic consistency.

RESULTS:

The mean gestational age at birth was 27 weeks (range 25 to 31) with an average weight of 1.147 kg (range 0.900 to 1.600) two trocars were placed as the focal oriented scanning or radiography, using a pneumoperitoneum 6-10 mmHg for an average of 17 min. Laparoscopy avoided laparotomy in a patient who did well after washing and drainage and magnified lesions in one patient who did not require laparotomy after intestinal bypass. In other cases, laparoscopy was followed by minilaparotomy oriented to the lesions and stoma formation. There were no surgical complications attributable to the procedure, which was well tolerated in all cases.

CONCLUSIONS:

Laparoscopy can be a useful tool for evaluation of lesions of NEC in cases of uncertain surgical indications. In our experience, it is well tolerated in neonates of low weight, allowing oriented minilaparotomies or even to avoid laparotomy.

Related Articles
Laparoscopy assists surgical decision making in infants with necrotizing enterocolitis.
J Pediatr Surg. 2004
Laparoscopy assists surgical decision making in infants with necrotizing enterocolitis.
Pierro A, Hall N, Ade-Ajayi A, Curry J, Kiely Em EM. J Pediatr Surg. 2004 Jun; 39(6):902-6; discussion 902-6.
[Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?].
Cir Pediatr. 2011
[Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?].
Argumosa Salazar Y, Fernández Córdoba MS, Gonzálvez Piñiera J, Hernández Anselmi E, Baquero Cano M, Medina Monzón C, Rubio Ruiz A, Martínez Gutiérrez A. Cir Pediatr. 2011 Aug; 24(3):142-5.
The role of diagnostic laparoscopy in micropremmies with suspected necrotizing enterocolitis.
Surg Endosc. 2007
The role of diagnostic laparoscopy in micropremmies with suspected necrotizing enterocolitis.
Tan HL, Tantoco JG, Ee MZ. Surg Endosc. 2007 Mar; 21(3):485-7. Epub 2006 Nov 14.
Review Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation.
J Perinatol. 2008
Review Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation.
Hunter CJ, Chokshi N, Ford HR. J Perinatol. 2008 May; 28 Suppl 1:S14-7.
Review Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants.
Cochrane Database Syst Rev. 2011
Review Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants.
Rao SC, Basani L, Simmer K, Samnakay N, Deshpande G. Cochrane Database Syst Rev. 2011 Jun 15; (6):CD006182. Epub 2011 Jun 15.