Laparoscopic Treatment of Postnecrotizing Enterocolitis Colonic Strictures

Abstract

The current report is a multicenter study of a series of infants who developed colonic strictures (CS) as a sequelae of necrotizing enterocolitis (NEC) and who were treated successfully with laparoscopic intestinal resection and primary anastomosis. During 2005-2008, 11 neonates (gestational ages, 32-38 weeks), with a mean birth weight of 1.7 kg (range, 0.96-2.2) and a mean weight at operation of 3.04 kg (range, 1.6-4.4 were approached laparoscopically, following the diagnosis of a post-NEC-CS. The two surgical techniques were: 1) laparoscopic mobilization with extracorporeal resection and anastomosis (LERA) in 4 (36%) and 2) laparoscopic mobilization with intracorporeal resection and anastomosis (LIRA) in 7 (64%) patients. Laparoscopy was effectively performed in all cases without conversion to open surgery. The median operative time was 93 minutes (range, 80-121). The anastomosis was colocolic in all patients, except in 1 case, in which it was colorectal. There were no operative complications. All babies recovered uneventfully and started oral feeding at a median time of 3.5 days (range, 1-11) postoperatively. Hospital discharge was at a median time of 9 days (range, 2-29) following operation. No recurrent strictures have developed.

Outcomes of diverting jejunostomy for severe necrotizing enterocolitis

“…It has previously been reported that intestinal strictures, commonly occurring in the colon, can develop from 3 weeks up to 3 months post-NEC and are best demonstrable on a contrast enema [13,15]. Traditionally, they have been resected at laparotomy as in our case [15][16][17].…”

Colonic Strictures after Necrotizing Enterocolitis in Infants: Case Series

“…Balloon catheters have also been used for dilatation of ischemic intestinal strictures, and this has obviated the need for surgical resection of the stricture or resulted in a more limited surgical procedure 4 . Recent studies have also demonstrated laparoscopic success in the management of intestinal strictures in the infantile period using either an intra-or extracorporeal resection and anastomosis 8 .…”

Laparoscopic intestinal stricture resection in premature newborn

“…Для резекции и конструирования анастомоза использовался метод, более известный как ЛИРА -лапароскопическая мобилизация с ин-тракорпоральной резекцией и анастомозом (англ. : LIRA -Laparoscopic mobilization with Intracorporeal Resection and Anastomosis) [14]. Первоначально выполнялась мобилизация пораженного сегмента толстой кишки путем пересечения перитонеальных складок, фиксирующих кишку (рис.…”

“…Известны 2 лапароскопических метода, которые могут быть использованы для лечения кишечных стриктур в зависимости от предпочтений хирурга и его навыков выполнения кишечного анастомоза [14]: 1) ЛЭРА -лапароскопическая мобилизация с экстракорпоральной резекцией и анастомозом (англ. : LERA -Laparoscopic mobilization with Extracorporeal Resection and Anastomosis) и 2) ЛИРА.…”

“…: LERA -Laparoscopic mobilization with Extracorporeal Resection and Anastomosis) и 2) ЛИРА. Наибольшее количество случаев использования лапароскопии в лечении пост-НЭК-стриктур было обобщено в мультицентровом исследовании на ма-териале 3 американских детских хирургических цен-тров и насчитывало только 13 пациентов [14]. Пост-НЭК-стриктуры располагались в области восходя-щей толстой кишки (1 пациент), печеночного угла (1), поперечной ободочной кишки (1), селезеноч-ного угла (5), нисходящей кишки (2), сигмовидной кишки (2) и прямой кишки (1).…”