title: Extensive Necrotising Enterocolitis: Objective Evaluation of the Role of Second-Look Laparotomy in Bowel Salvage and Survival.
abstract: OBJECTIVE
  We investigated the role and outcome of a planned second-look laparotomy (SLL) in preserving bowel in extensive necrotizing enterocolitis (NEC).
  
  
  METHODS
  Extensive NECs managed surgically in a tertiary centre in 2006-2009 were retrospectively studied to include patients planned for an SLL. End points were bowel salvage rate and survival outcomes. Results were median (ranges), and statistical significance was P < 0.05.
  
  
  RESULTS
  In 4 years, 34 NECs required a laparotomy, and 9 extensive NECs who required an SLL were included. The gestation at birth was 27 (24-38) weeks, birth weight was 1120 (580-2835) g, and first laparotomy performed on day 34 (2-77) of life, with SLL performed 2 (1-3) days after initial laparotomy. Commonest indications for SLL were doubtful bowel viability and physiological instability. 3 died before SLL. Patients who survived to have an SLL (n = 6) had remaining small bowel length of 41 (25-70) cm, overall small bowel salvage rate 51 % (0-100 %), and 30-day survival 5/6 (83 %). Four patients survived for 1 year, their length of NICU stay was 114 (76-120) postoperative days, time on PN was 84 postoperative days (71 days-17 months), including one patient with short bowel syndrome who achieved enteral autonomy at 17 months; one late mortality had short bowel syndrome after further bowel resection for bowel obstruction, developed intestinal failure associated liver disease, and died before 1 year of life following liver transplant.
  
  
  CONCLUSIONS
  SLL is a viable approach for extensive NEC. It offered bowel salvage rate of 51 % and long-term PN-free survival of 44 %, in the patient group who would have had significant risk of mortality and major morbidity.
authors: Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK. ywtan80@doctors.net.uk.
authors: Yew-Wei
authors: YW
authors: Tan
authors: Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK.
authors: Julia
authors: J
authors: Merchant
authors: Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK.
authors: Videha
authors: V
authors: Sharma
authors: Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK.
authors: Brian
authors: B
authors: Davies
authors: Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK.
authors: Shailinder
authors: S
authors: Singh
authors: Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK.
authors: Richard
authors: R
authors: Stewart
authors: Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospital, Derby Road, Nottingham, NG7 2UH, UK.
authors: Bharat
authors: B
authors: More
mesh_terms: D001724:Birth Weight; D020345:Enterocolitis, Necrotizing / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008297:Male; D059351:Organ Sparing Treatments; D012189:Retrospective Studies; D016879:Salvage Therapy; D024162:Second-Look Surgery; D015996:Survival Rate; D016896:Treatment Outcome