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Laparoscopic localization and microlaparotomy for focal isolated perforation in necrotizing enterocolitis: an
Shireen A Nah1, Hock-Lim Tan, Riana P Tamba
1Department of Paediatric Surgery, National University of Malaysia (UKM), Kuala Lumpur, Malaysia.
Background:
Necrotizing enterocolitis has a wide clinical spectrum of manifestation. We report a novel method of managing focal isolated perforation in necrotizing enterocolitis by using diagnostic laparoscopy to localize the site of perforation and by making a microincision over the perforation to perform exteriorization or limited resection and primary anastomosis.
Methods:
We included low-birth weight infants presenting with sudden clinical deterioration and pneumoperitoneum. Patients with gross abdominal wall signs were excluded on the probability that they had extensive disease. Diagnostic laparoscopy was performed using a 3.5-mm trocar and 1.9-mm telescope. A 1-cm incision was made over the site of perforation, and local surgical debridement was performed.
Results:
There were 3 extremely low-birth weight patients (580, 700, and 780 g) and 1 larger infant (1.6 kg). In all cases, an isolated perforation was detected. None had widespread disease. The 3 smaller infants had exteriorization and enterostomies. The larger patient had resection and primary anastomosis. All patients recovered uneventfully.
Conclusion:
Diagnostic laparoscopy can be safely performed in extremely low-birth weight infants. It allows precise identification of the site of perforation to perform a limited microlaparotomy at this site, significantly reducing the surgical trauma of extensive bowel handling. We report a novel method of managing this vexing problem.
Insights
This study introduces a novel laparoscopic technique for managing focal perforations in necrotizing enterocolitis (NEC) in infants. The method uses diagnostic laparoscopy and microincisions to reduce surgical trauma, leading to successful outcomes.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Minimally invasive surgery
Background:
- Necrotizing enterocolitis (NEC) presents with diverse clinical manifestations.
- Focal isolated perforation is a specific challenge in NEC management.
- Traditional approaches may involve extensive surgical intervention.
Purpose of the Study:
- To report a novel minimally invasive surgical method for managing focal isolated perforations in NEC.
- To evaluate the safety and efficacy of diagnostic laparoscopy and microlaparotomy in low-birth weight infants with NEC.
Main Methods:
- Inclusion of low-birth weight infants with sudden deterioration and pneumoperitoneum, excluding those with extensive disease.
- Performance of diagnostic laparoscopy using a 3.5-mm trocar and 1.9-mm telescope.
- Creation of a 1-cm incision at the perforation site for exteriorization or limited resection and anastomosis.
Main Results:
- Four infants (3 extremely low-birth weight, 1 larger) with isolated perforations were treated.
- Successful outcomes were achieved in all patients, with 3 undergoing exteriorization and 1 having resection and primary anastomosis.
- No widespread disease was noted in any of the cases.
Conclusions:
- Diagnostic laparoscopy is a safe and effective tool for identifying perforation sites in extremely low-birth weight infants.
- This technique allows for precise microlaparotomy, significantly reducing surgical trauma and bowel handling.
- The reported method offers a novel solution for managing focal perforations in NEC.
