The role of diagnostic laparoscopy in micropremmies with suspected necrotizing enterocolitis

H. L. Tan, J. G. Tantoco, M. Z. Ee

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The timely diagnosis of perforations or dead gut can be extremely difficult in micropremmies with necrotizing enterocolitis. A negative laparotomy is just as detrimental as failure to recognize early perforation in this group of patients. We have been exploring the role of microlaparoscopy using a needlescope to determine if this modality is feasible and useful in the surgical management of these patients. We report our technique and initial experience with needlescopic diagnosis. Methods: Four patients (weight >500 to <1000 g) with abdominal distension and clinical sepsis not responsive to aggressive medical treatment were included in this study. None had radiologic evidence of pneumatosis or perforation. There was no absolute surgical indication for laparotomy except for strong suspicion of a surgical cause. Needlescopic diagnosis was performed in all these patients. Results: There was no evidence of perforation or bile in the abdominal cavity in one patient. This patient improved on medical management, avoiding a laparotomy. The rest had bile or fibrin in the abdominal fluid with a localized perforation, and in each case we performed a microlaparotomy directly over the site of perforation to create a stoma. Conclusions: Needlescopic diagnosis is feasible and appears to be safe, even in critically ill micropremmies less than 1000 g. The technique can provide useful information for surgical decision-making and allows for precise placement of a microlaparotomy incision over the site of perforation, thus minimizing the trauma from open surgery in this special group of patients. We are currently expanding its role in patients with overt perforations to determine if we can limit the extent of surgical exploration without compromising the adequacy of surgical management.

Original languageEnglish
Pages (from-to)485-487
Number of pages3
JournalSurgical Endoscopy and Other Interventional Techniques
Volume21
Issue number3
DOIs
Publication statusPublished - Mar 2007
Externally publishedYes

Fingerprint

Necrotizing Enterocolitis
Laparoscopy
Laparotomy
Bile
Abdominal Cavity
Fibrin
Critical Illness
Sepsis
Decision Making
Weights and Measures
Wounds and Injuries

Keywords

  • Laparoscopy
  • Necrotizing enterocolitis

ASJC Scopus subject areas

  • Surgery

Cite this

The role of diagnostic laparoscopy in micropremmies with suspected necrotizing enterocolitis. / Tan, H. L.; Tantoco, J. G.; Ee, M. Z.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 21, No. 3, 03.2007, p. 485-487.

Research output: Contribution to journalArticle

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