Extensive Necrotising Enterocolitis: Objective Evaluation of the Role of Second‐Look Laparotomy in Bowel Salvage and Survival

• DOI: 10.1007/s00268-015-3203-5
• Publication Date: 2015-08-25T06:42:49Z
• Authors: Yew‐Wei Tan; Julia Merchant; Videha Sharma; Brian Davies; Shailinder Singh; Richard Stewart; Bharat More
• Keywords: Male; Salvage Therapy; Infant, Newborn; Infant; Gestational Age; 3. Good health; Survival Rate; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Enterocolitis, Necrotizing; Second-Look Surgery; Intensive Care Units, Neonatal; Birth Weight; Humans; Female; Organ Sparing Treatments; Follow-Up Studies; Retrospective Studies

AbstractAimWe investigated the role and outcome of a planned second‐look laparotomy (SLL) in preserving bowel in extensive necrotizing enterocolitis (NEC).MethodsExtensive NECs managed surgically in a tertiary centre in 2006–2009 were retrospectively studied to include patients planned for an SLL. End points were bowel salvage rate and survival outcomes. Results were median (ranges), and statistical significance was P < 0.05.Main resultsIn 4 years, 34 NECs required a laparotomy, and 9 extensive NECs who required an SLL were included. The gestation at birth was 27 (24–38) weeks, birth weight was 1120 (580–2835) g, and first laparotomy performed on day 34 (2–77) of life, with SLL performed 2 (1–3) days after initial laparotomy. Commonest indications for SLL were doubtful bowel viability and physiological instability. 3 died before SLL. Patients who survived to have an SLL (n = 6) had remaining small bowel length of 41 (25–70) cm, overall small bowel salvage rate 51 % (0–100 %), and 30‐day survival 5/6 (83 %). Four patients survived for 1 year, their length of NICU stay was 114 (76–120) postoperative days, time on PN was 84 postoperative days (71 days–17 months), including one patient with short bowel syndrome who achieved enteral autonomy at 17 months; one late mortality had short bowel syndrome after further bowel resection for bowel obstruction, developed intestinal failure associated liver disease, and died before 1 year of life following liver transplant.ConclusionSLL is a viable approach for extensive NEC. It offered bowel salvage rate of 51 % and long‐term PN‐free survival of 44 %, in the patient group who would have had significant risk of mortality and major morbidity.