Late Abdominal Reoperations after Surgery for Necrotizing Enterocolitis and Spontaneous Intestinal Perforation

Abstract

Introduction The aim of this study was retrospective assessment of late major reoperations after surgery for necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in neonates.

Materials and Methods Appropriate ethical consent was obtained. Data collection was by review of hospital records of 165 successive prematures who underwent surgery for NEC (n = 99) or SIP (n = 66) from 1986 to 2019. Outcome measures were late major abdominal surgeries or endoscopies that occurred after the primary surgical treatment, closure of enterostomies, and weaning from parenteral nutrition (PN). We assessed also risk factors for late abdominal surgeries.

Results Hundred and twenty-six (76%) patients (NEC, n = 70, 71% and in SIP, n = 56, 85%) survived. Median follow-up was 13 (interquartile range: 5.9–23) years. Nineteen (15%) patients underwent late abdominal surgery with 0% mortality. Most common was surgery for small bowel obstruction (SBO) in 12(9.5%) patients (NEC, n = 5; 7.0%, SIP, n = 7; 13%, p = 0.36) with 10-year cumulative risk of 8.7 (95% confidence interval [CI]: 3.5–14). Long duration of PN and development of intestinal failure associated cholestasis (IFAC) increased the risk of SBO surgery, relative risk: 1.0–3.2 (95% CI: 1.0–9.1), p = 0.02–0.03. Other surgeries included serial transverse enteroplasty (NEC, n = 2), incisional hernia repair (n = 3), cholecystectomy (n = 1), and ovarian torsion (n = 1). Twenty (29%) NEC and four (7%) SIP patients required endoscopic assessment of postoperative symptoms (p = 0.003).

Conclusion Late abdominal reoperations occurred in 15% of patients with NEC and SIP with nil mortality. SBO was the main indication. Risk of SBO was similar between NEC and SIP. Long PN and IFAC increased the risk of SBO.

Keywords

necrotizing enterocolitis - spontaneous intestinal perforation - reoperations - small bowel obstruction

Publication History

Received: 10 July 2020

Accepted: 11 November 2020

Article published online:
13 January 2021

• References

• 1 Zbar RI, Crede WB, McKhann CF, Jekel JF. The postoperative incidence of small bowel obstruction following standard, open appendectomy and cholecystectomy: a six-year retrospective cohort study at Yale-New Haven Hospital. Conn Med 1993; 57 (03) 123-127
• 2 Ahlberg G, Bergdahl S, Rutqvist J, Söderquist C, Frenckner B. Mechanical small-bowel obstruction after conventional appendectomy in children. Eur J Pediatr Surg 1997; 7 (01) 13-15
• 3 Karila K, Anttila A, Iber T, Pakarinen M, Koivusalo A. Outcomes of surgery for necrotizing enterocolitis and spontaneous intestinal perforation in Finland during 1986-2014. J Pediatr Surg 2018; 53 (10) 1928-1932
• 4 Downard CD, Renaud E, St Peter SD. et al; 2012 American Pediatric Surgical Association Outcomes Clinical Trials Committee. Treatment of necrotizing enterocolitis: an American pediatric surgical association outcomes and clinical trials committee systematic review. J Pediatr Surg 2012; 47 (11) 2111-2122
• 5 Hukkinen M, Kivisaari R, Koivusalo A, Pakarinen MP. Risk factors and outcomes of tapering surgery for small intestinal dilatation in pediatric short bowel syndrome. J Pediatr Surg 2017; 52 (07) 1121-1127
• 6 Struijs MC, Diamond IR, de Silva N, Wales PW. Establishing norms for intestinal length in children. J Pediatr Surg 2009; 44 (05) 933-938
• 7 Tsao KJ, St Peter SD, Valusek PA. et al. Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg 2007; 42 (06) 939-942
• 8 Beck DE, Opelka FG, Bailey HR, Rauh SM, Pashos CL. Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery. Published Correction Appears in Dis Colon Rectum 1999; 42 (02) 241-248
• 9 Nyholm I, Hukkinen M, Koivusalo A. et al. Long-term single-centre outcomes after proctocolectomy with ileoanal anastomosis for paediatric ulcerative colitis. J Crohn's Colitis 2019; 13 (03) 302-308
• 10 Fredriksson F, Christofferson RH, Lilja HE. Adhesive small bowel obstruction after laparotomy during infancy. Br J Surg 2016; 103 (03) 284-289
• 11 Liu W, Wang Y, Zhu J. et al. Clinical features and management of post-necrotizing enterocolitis strictures in infants: a multicentre retrospective study. Medicine (Baltimore) 2020; 99 (19) e20209
• 12 Hau EM, Meyer SC, Berger S, Goutaki M, Kordasz M, Kessler U. Gastrointestinal sequelae after surgery for necrotising enterocolitis: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2019; 104 (03) F265-F273
• 13 Bass LM, Zimont J, Prozialeck J, Superina R, Cohran V. Intestinal anastomotic ulcers in children with short bowel syndrome and anemia detected by capsule endoscopy. J Pediatr Gastroenterol Nutr 2015; 61 (02) 215-219
• 14 van der Wal JB, Iordens GI, Vrijland WW, van Veen RN, Lange J, Jeekel J. Adhesion prevention during laparotomy: long-term follow-up of a randomized clinical trial. Ann Surg 2011; 253 (06) 1118-1121
• 15 Miyake H, Seo S, Pierro A. Laparoscopy or laparotomy for adhesive bowel obstruction in children: a systematic review and meta-analysis. Pediatr Surg Int 2018; 34 (02) 177-182