What role does laparoscopy play in the diagnosis and immediate treatment of infants with necrotizing enterocolitis?

PURPOSE: Laparotomy is the preferred option for the surgical treatment of necrotizing enterocolitis (NEC); however, laparoscopy may offer benefit, particularly when it is uncertain if the operation is necessary. Our aim was to review the current evidence for the use of diagnostic and therapeutic laparoscopy in NEC.

MATERIALS AND

METHODS

A systematic review of published literature (1990-July 2012) found in MEDLINE, EMBASE, the Cochrane Library Controlled Trials Register, and the Cumulative Index to Nursing and Allied Health reporting the use of laparoscopy for management of acute NEC was undertaken.

RESULTS

Seven studies (six case series and one case report) reporting the use of laparoscopy in 44 infants (weighing 0.5-2.9 kg) with NEC were identified and included for review. There were no randomized controlled trials. Laparoscopic techniques differed among the studies, with standard laparoscopy (gas) used in 28 (64%) cases, fluorescein-aided assessment in 8 cases (18%), and gasless laparoscopy in 8 cases. Eight (18%) infants did not require further surgery following laparoscopy: 4 (9%) had no evidence of NEC, 2 (5%) had no evidence of perforation and/or intestinal gangrene, and 2 (5%) had NEC totalis precluding further surgery. In the remaining 36 (86%) infants in whom further procedures were required following laparoscopy, 9 had placement of a peritoneal drain, 20 had a stoma, and 7 had intestinal anastomosis. Perforation was detected in 25 (57%) infants; however, among the 19 infants who had no detectable perforation at initial laparoscopy, 1 infant (5%) subsequently required laparotomy for a missed perforation. Six (14%) infants died: 2 had care withdrawn due to pan-intestinal NEC, 2 died of ongoing NEC, and 2 of recurrent NEC following recovery from the acute episode.

CONCLUSIONS

Laparoscopy is a useful tool in the armamentarium of surgical management of NEC, with one-fifth of patients not requiring further surgery. Laparoscopy can be useful in selected babies with suspected NEC to avoid unnecessary laparotomy and minimize the trauma of surgery.