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Laparotomy in very small premature infants with necrotizing enterocolitis or focal intestinal perforation:
Alfonso Camberos1, Kaushal Patel, Harry Applebaum
1Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90027, USA.
Background/Purpose:
Laparotomy for peritonitis secondary to necrotizing enterocolitis (NEC) or focal intestinal perforation (FIP) has been supplanted by peritoneal drainage (PD) as the initial treatment in many institutions. Although proponents regard it as a safer alternative, early mortality is cited between 21% and 36%, with subsequent laparotomy required for worsening disease in 26% to 83% of patients. The current outcomes for initial laparotomy are analyzed and compared with those cited for PD.
Methods:
A retrospective review of very small premature infants less than 1,500 g undergoing laparotomy for NEC or FIP between 1994 and 2000 was performed.
Results:
Thirty-five neonates were identified with a median weight of 741 g (range, 460 g to 1,415 g) and a median age of 26 weeks (range, 23 to 33 weeks). Twelve patients had FIP and 23 had NEC including 5 with pan-intestinal necrosis (PIN). No deaths occurred during laparotomy or stoma closure. Seven (20%) patients died within the immediate 7-day postoperative period. Nine (26%) patients died in the 30-day postoperative period.
Conclusions:
With current peri-operative management, mortality rates for initial laparotomy and PD are comparable. Assessing the extent of disease and removing necrotic bowel at initial laparotomy can hasten recovery and eventual discharge while enabling informed surgical decision making and advice to parents.