Eur J Pediatr Surg 2015; 25(01): 41-45
DOI: 10.1055/s-0034-1387940
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Vacuum-Assisted Closure: A Novel Method of Managing Surgical Necrotizing Enterocolitis

Stephanie Sea
1   Department of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
,
Teerin Meckmongkol
1   Department of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
,
Matthew L. Moront
1   Department of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
,
Shaheen Timmapuri
1   Department of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
,
Rajeev Prasad
1   Department of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
,
Marshall Z. Schwartz
1   Department of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
,
L. Grier Arthur
1   Department of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

18 May 2014

23 June 2014

Publication Date:
30 August 2014 (online)

Abstract

Purpose Necrotizing enterocolitis (NEC) requiring surgical intervention is associated with mortality rates approaching 50%. We evaluated outcomes of patients that underwent surgical treatment for NEC with vacuum-assisted closure (VAC) of the abdomen as compared with traditional laparotomy, bowel resection, and ostomy creation.

Methods A retrospective review identified 26 patients from 2007 to 2012 with NEC. Overall, 17 patients were treated with laparotomy, and 9 were treated with laparotomy and VAC (LapVac). Age, weight, preoperative and postoperative mean airway pressure, length of bowel resected, duration on total peripheral nutrition, time until initiation of feeds, and length of stay were assessed. A Student's t-test was used for statistical analysis.

Results Nine LapVac patients underwent a total of 1.2 ± 1.3 VAC changes and had open abdomens for 13.1 ± 19.1 days. LapVac and traditional laparotomy patients had similar outcomes with respect to amount of bowel resected, time on a ventilator, time to initiation of feeds, and length of hospital stay. Two of nine patients (22%) in the LapVac group were placed in continuity without the need for an ostomy. We identified a subset of patients in the LapVac group that demonstrated signs of abdominal compartment syndrome (ACS), exhibiting mean airway pressures greater than 15 cm H2O preoperatively. Patients with ACS treated with VAC therapy had shorter time to initiation of feeds (p = 0.047) and shorter lengths of stay (p = 0.0395) as compared with traditional laparotomy.

Conclusion Our data demonstrate that use of the wound VAC is a safe approach in the management of premature infants with NEC requiring surgical intervention with outcomes comparable to standard surgical management. Use of the wound VAC may allow the establishment of bowel continuity and abdominal closure without the need for an ostomy. VAC therapy may also hasten the recovery of NEC patients with concomitant ACS by eliminating the compartment syndrome. Larger studies are required to confirm this theory.

 
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