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Early laparoscopic-assisted surgery is associated with decreased post-operative inflammation and intestinal strictures in infants with necrotizing enterocolitis

  • Louise Montalva
    Correspondence
    Corresponding author. , Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital 48 Boulevard Sérurier 75019 Paris, France
    Affiliations
    Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France

    University Paris-Cité, Paris, France
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  • Filippo Incerti
    Affiliations
    Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France

    University Paris-Cité, Paris, France
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  • Livia Qoshe
    Affiliations
    Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France

    Princeton Internships in Civic Service, Princeton University, Princeton, NJ, USA
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  • Aurore Haffreingue
    Affiliations
    Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
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  • Lucile Marsac
    Affiliations
    Department of Pediatric Anesthesia, Intensive Care and Pain Management, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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  • Alice Frérot
    Affiliations
    Neonatal Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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  • Matthieu Peycelon
    Affiliations
    Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France

    University Paris-Cité, Paris, France
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  • Valérie Biran
    Affiliations
    Neonatal Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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  • Arnaud Bonnard
    Affiliations
    Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France

    University Paris-Cité, Paris, France
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Published:November 22, 2022DOI:https://doi.org/10.1016/j.jpedsurg.2022.11.007

      Abstract

      Introduction

      In 2015, a protocol including early laparoscopy-assisted surgery in the treatment of necrotizing enterocolitis (NEC) was implemented at our institution. Carbon dioxide insufflation during laparoscopy may have an anti-inflammatory effect. We aimed to compare post-operative outcome after early laparoscopy-assisted surgery and classical laparotomy for NEC.

      Material and methods

      Charts of premature infants undergoing surgery for NEC (2012-2021) were reviewed. Cases operated by early laparoscopy-assisted surgery (2015-2021) were compared to infants operated for NEC between 2012-2015 (laparotomy-NEC). Outcomes were post-operative CRP, need for reintervention, mortality, and the occurrence of post-NEC intestinal strictures. CRP was measured on the day of surgery (POD-0), 2 days (POD-2), and 7 days after surgery (POD-7). Data were compared using contingency tables for categorical variables and Student t-test or Mann-Whitney test for continuous variables.

      Results

      Infants with NEC operated by early laparoscopy (n=48) and laparotomy (n=29) were similar in terms of perforation (60% vs 58%, p=0.99) and POD-0 CRP (139 vs 124mg/L, p=0.94). Delay between first signs of NEC and surgery was shorter in the laparoscopy group (3 vs 6 days, p=0.004). Early laparoscopy was associated with a lower CRP on POD-2 (108 vs 170, p=0.005) and POD-7 (37 vs 68, p=0.002), as well as a lower rate of post-operative intestinal stricture (34% vs 61%, p=0.04).

      Conclusions

      In addition to being safe and feasible in premature infants, early laparoscopic-assisted surgery was associated with decreased NEC-related post-operative inflammation and strictures. A prospective, randomized study is needed in order to evaluate short and long-term effects of laparoscopy in infants with NEC.

      Level of Evidence

      Level III

      Keywords

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