The role of laparoscopy in newborns affected by NEC.
BACKGROUND
For many years, laparoscopic procedures have been reported in the literature in pediatrics also. In this article, we report their experiences of the use of gasless laparoscopy in 8 newborns affected by necrotizing enterocolitis (NEC).


METHODS
From January 2007 to May 2008, 8 patients affected by stage 1-2 NEC were treated at the Department of Pediatric Surgery, Fondazione Policlinico Milan (Milan, Italy). Of those, 3 patients presented with a birth weight below 1.5 kg.


RESULTS
All patients were submitted at gasless laparoscopy. In 6 of 8 patients, a covered perforation was detected; in 5 cases, the perforation was on the posterior wall of the ascending colon, and in 1, a perforation of the transverse colon was detected. In these 6 of 8 patients, the procedure was converted to formal laparotomy, with colonic resection and primary anastomosis. In 2 of 8 patients, a diffuse necrotizing enteritis of the small bowel was reported, without evidence of perforation; two drains were placed and continued abdominal washout with antibiotics solution was maintained for 48 hours, associated with systemic therapy. All patients were maintained on systemic antibiotic therapy for 7 days with regression of sepsis; all patients survived and were discharged in good general condition. At follow-up of 3 months, none of the patients presented with complications.


CONCLUSIONS
We believe that the decision to perform a laparoscopy, despite the very low weight of the patient, was crucial in the management of nondetected perforation at X-ray. Retrospectively, laparoscopy would be the best option to define the presence of NEC without a perforation, which may only require washout of the cavity that can be also managed with this technique.


CONCLUSIONS
We believe that laparoscopy can be easily managed also in newborns and small for gestational age neonates, reducing the morbidity of laparotomy for suspicion of perforation in patients affected by NEC who do not respond to medical treatment.
Leva
Ernesto
E
Department of Pediatric Surgery, IRCCS Fondazione Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milano, Italy. ernleva@tin.it
Di Cesare
Antonio
A
Canazza
Lorena
L
Arnoldi
Rossella
R
Macchini
Francesco
F
Rossi
Vincenzo
V
Colnaghi
Maria Rosa
MR
Pugni
Lorenza
L
Mosca
Fabio
F
Torricelli
Maurizio
M
D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome