Primary peritoneal drainage in necrotising enterocolitis: an 18-year experience
A Goyal1, L R Manalang, S C Donnell
1Department of Paediatric Surgery, Royal Liverpool Children's Hospital, Alder Hey, Liverpool L12 2AP, UK. dranjugoyal@yahoo.com
Pediatric Surgery International
|May 2, 2006
Summary
Primary peritoneal drainage (PPD) is a viable option for necrotizing enterocolitis (NEC) in infants. While not a definitive strategy, response to PPD effectively predicts survival outcomes.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Critical care medicine
Background:
- Primary peritoneal drainage (PPD) was developed for pre-operative resuscitation in infants with complicated necrotizing enterocolitis (NEC).
- Its use as a definitive treatment for extremely low birth weight infants and the necessity of laparotomy in non-responders have been debated.
Purpose of the Study:
- To analyze the 18-year experience with PPD as an initial surgical management for infants with NEC.
- To evaluate the efficacy of PPD and the role of subsequent laparotomy.
Main Methods:
- Retrospective review of all NEC patients undergoing PPD as initial surgical management over 18 years.
- Analysis of survival rates, clinical response to PPD, and outcomes of rescue laparotomy.
Main Results:
- Of 122 NEC patients treated surgically, 42 had initial PPD, with 28 survivors (67%).
- Infants with a good clinical response to PPD had 80% survival, versus 27% for non-responders.
- Six patients underwent rescue laparotomy after poor PPD response, with 3 survivors. Isolated intestinal perforations did not differ clinically from typical NEC.
Conclusions:
- PPD is a useful option for complicated NEC management, but not solely a definitive strategy.
- Response to PPD is a strong prognostic indicator for survival.
- Early laparotomy is indicated for infants who do not respond to PPD, despite a lower salvage rate in this group.
