Bedside Mini-laparoscopy Could Spare Non-Therapeutic Laparotomy For Neonates With Necrotizing Enterocolitis
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This study was conducted to evaluate applicability of preoperative investigations to aid surgical decision-making in patients with necrotizing enterocolitis (NEC) and comprised 53 neonates with 25-32 weeks gestational age. All patients underwent clinical examination, laboratory and radiological investigations that included abdominal plain X-ray for assessment of presence and degree of pneumatosis intestinalis (Pn Int), portal venous air (P VA) and pneumoperitoneum (PP). Bedside diagnostic mini-laparoscopy was performed for all patients. Then, exploratory laparotomy was carried out and surgical decision was taken according to the pathological lesions present Radiological examination defined PP in 10, PVA in 7 patients while Pn. Int was detected in 45 patients, 19 grade I, 20 grade II and 6 grade III. Laparoscopy identified pan-necrosis in 8 cases, long-segment necrosis in 6 cases, 10 cases with perforation and 29 with localized peritonitis with somewhat healthy intestine. At laparotomy, pan-necrosis was confronted with in 8 cases that underwent non-therapeutic laparotomy (NTL) and drainage, 8 patients had long jejunal loop necrosis; 6 of them required resection and stoma formation and 2 underwent defimctioning jejunostomy, 7 patients had multiple perforations and multiple resections and stomas were performed, 4 patients had single perforation and underwent resection and primary anastomosis, 3 cases had colonic perforation and localized peritonitis and underwent colonic resection and proximal colostomy and 23 cases had localized collections that were drained Postoperatively, 27 patients (50.9%) died, 6 patients had stoma! prolapse, 10 had wound infection and 3 of them had wound dehiscence with a complication rate among survivors of 61.5%.li could be concluded that laparoscopy could spare NTL with accuracy 100% in advanced cases and define cases required simple drainage with accuracy 90.5%. Test validity criteria showed a significant (Pc 0.05) difference in favor of laparoscopy compared to presence of hi. Int. grade III, (X2=4.2), PVA, e =7.8) and thrombocytopenia, (X=3.18). Using the receiver operating characteristic (ROC) curve analysis judged by the area under the curve (AUC) revealed that laparoscopy is highly sensitive and specific diagnostic modality with AUC=1 helping in surgical decision-making to abandon laparotomy. It could be concluded that preoperative bedside laparoscopy could spare laparotomy in cases with advanced NEC with accuracy 100%.