Eur J Pediatr Surg 2012; 22(01): 085-090
DOI: 10.1055/s-0031-1291287
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Clip and Drop Back Technique in the Management of Multifocal Necrotizing Enterocolitis: a Single Centre Experience

K.K.Y. Pang
1  Division of Paediatric Surgery,  Department of Surgery, Queen Elizabeth Hospital, Hong Kong
,
N.S.Y. Chao
1  Division of Paediatric Surgery,  Department of Surgery, Queen Elizabeth Hospital, Hong Kong
,
B.P.Y. Wong
2  Division of Pediatric Surgery, Department of Surgery, United Christian Hospital, Hong Kong
,
M.W.Y. Leung
1  Division of Paediatric Surgery,  Department of Surgery, Queen Elizabeth Hospital, Hong Kong
,
K.K.W. Liu
2  Division of Pediatric Surgery, Department of Surgery, United Christian Hospital, Hong Kong
› Author Affiliations
Further Information

Publication History

15 May 2011

21 September 2011

Publication Date:
07 December 2011 (online)

Abstract

Aim The surgical management of multifocal necrotizing enterocolitis (NEC) remains a major challenge. The “clip-and-drop” strategy with a second-look laparotomy permits re-assessment of bowel viability after optimization, thus offering the potential of both improving survival and conserving bowel length. This study reviews the outcome of this strategy in a single regional center.

Methods Since 2000, NEC patients undergoing emergency laparotomy selectively underwent a “clip-and-drop” operation if there was peri-operative instability and/or multifocal disease with uncertain bowel viability. Bowel with full thickness gangrene was resected and bowel-ends were temporarily tied-off; a second-look definitive procedure was performed when the patient had stabilized. For this review, in-hospital and follow-up records were studied retrospectively for demographics, 30-day mortality and long-term outcome.

Main results Between 2000 and 2010, 16 patients underwent a “clip-and-drop” operation. The mean post-conception age was 32.8 weeks (27.7–41.7 weeks) with a median body weight of 1.4 kg (0.76–4.4 kg) at first operation. Preoperative radiograph showed free gas in 43.8% and portal venous gas in 37.5% of patients. 2 patients did not survive to the second laparotomy. 14 patients received a second laparotomy, after a mean of 51 h (35–74 h). 2 patients were found to suffer from NEC totalis on the second laparotomy and died without further procedures. All other patients (n = 12) had stoma formation. 1 patient died 4 days after stoma formation. The 30-day mortality for NEC with the “clip-and-drop” strategy was 31.6% (5/16). Among the 11 survivors, 1 died from liver failure complicated by short bowel syndrome at 5 months post operation, 2 others died from respiratory complications of prematurity despite adequate gastrointestinal function. The median follow-up time for the 8 long-term survivors was 45 months (7–129 months). Their median time to achieving full feeds was 41 days (range 21–105 days) after the second operation.

Conclusion The “clip-and-drop” strategy, when used in selected patients with multifocal NEC, may help bowel conservation in survivors.