A Pierro1, N Hall, A Ade-Ajayi, J Curry, E M Kiely Em. 1. Department of Paediatric Surgery, Great Ormond Street Hospital and the Institute of Child Health, London, England, UK.
Abstract
BACKGROUND: Lack of specific indications for surgical intervention is not uncommon in critically ill infants with necrotizing enterocolitis (NEC). The authors hypothesized that knowledge of the extent of intestinal disease would assist in deciding the operative treatment of choice. The authors report that initial experience with laparoscopy in infants with NEC. METHODS: Prospective evaluation was done of 11 infants with a clinical diagnosis of NEC who were deteriorating despite maximal medical therapy. All underwent laparoscopy on the intensive care unit (ICU). RESULTS: Median gestational age at birth was 29 weeks (range, 24 to 34) and median weight at the time of laparoscopy was 1.2 kg (range, 0.6 to 2.9). Laparoscopy was tolerated well in all cases. NEC was excluded because of the normal intestinal appearance in 2 infants and confirmed in the remaining 9. Urgent laparotomy was avoided in 8 infants, in one of whom a laparoscopically guided ileostomy was performed. In 5 infants, a Penrose drain was inserted at laparoscopy; 3 of these did not require further surgery, and the remaining 2 underwent delayed laparotomy. Three infants, all with intestinal gangrene, died. CONCLUSIONS: Laparoscopy performed in the ICU can provide information regarding intestinal viability which can guide further surgical management. It is feasible and tolerated well even in critically ill neonates less than 1,000 g.
BACKGROUND: Lack of specific indications for surgical intervention is not uncommon in critically ill infants with necrotizing enterocolitis (NEC). The authors hypothesized that knowledge of the extent of intestinal disease would assist in deciding the operative treatment of choice. The authors report that initial experience with laparoscopy in infants with NEC. METHODS: Prospective evaluation was done of 11 infants with a clinical diagnosis of NEC who were deteriorating despite maximal medical therapy. All underwent laparoscopy on the intensive care unit (ICU). RESULTS: Median gestational age at birth was 29 weeks (range, 24 to 34) and median weight at the time of laparoscopy was 1.2 kg (range, 0.6 to 2.9). Laparoscopy was tolerated well in all cases. NEC was excluded because of the normal intestinal appearance in 2 infants and confirmed in the remaining 9. Urgent laparotomy was avoided in 8 infants, in one of whom a laparoscopically guided ileostomy was performed. In 5 infants, a Penrose drain was inserted at laparoscopy; 3 of these did not require further surgery, and the remaining 2 underwent delayed laparotomy. Three infants, all with intestinal gangrene, died. CONCLUSIONS: Laparoscopy performed in the ICU can provide information regarding intestinal viability which can guide further surgical management. It is feasible and tolerated well even in critically ill neonates less than 1,000 g.