[Rethinking the surgical approach to intestinal obstruction surgery in neonates. Experience of a third-level...

Choosing laparotomy incision (transverse or midline) depends on the area that needs to be exposed, the urgency of the procedure, and the surgeon's preference. In the Hospital de Pediatría of the Centro Médico Nacional Siglo XXI of the IMSS, the traditional approach is performed by midline in these patients. Our objective was to determine if the midline approach is safe for handling neonates undergoing laparotomy for intestinal obstruction.

A retrospective study included all neonates who underwent laparotomy for intestinal obstruction by midline approach in the period from January 2010 to January 2012.

34 patients were studied. 88.2 % were urgency procedures; surgery time was more than 120 minutes. Surgical bleeding in all patients was less than 20 milliliters. Complications were found in 44 % of patients, of which the most frequent was infection (29 %) and wound dehiscence (20 %). As for respiratory complications, 32.4 % had atelectasis and 14.7 %, pneumonia. 14.7 % had incisional hernia at one year.

The frequency of immediate and non-immediate post-surgical complications is higher than those reported in the literature with transverse approach. The frequency of post-incisional hernia at one year is similar to that reported with the latter approach.