A Single-Center Experience with Very Low Birth Weight Infants and Focal Intestinal Perforation: Comparison of Primary Anastomosis versus Stoma Opening

Abstract

Introduction We present a single-center experience with very low birth weight (VLBW) infants with focal intestinal perforation (FIP), comparing the results of primary anastomosis (PA) and stoma opening (SO).

Materials and Methods Clinical records of VLBW infants with FIP who underwent surgery between 2006 and 2015 were reviewed. Patients were divided into two groups according to the procedure performed: limited bowel resection and PA or SO. Patients with gastric perforation or patients who underwent clip and drop were excluded. Information regarding birth weight (BW), gestational age (GA), weight at surgery (WS), number of abdominal reoperations, duration of parenteral nutrition (PN), and demise was recorded.

Results In this study, 40 patients were included: 22 in PA group and 18 in SO group. BW was 865 g in PA and 778 in SO (p-value: 0.2). GA was 26.1 weeks in PA and 25.6 in SO (p-value: 0.3). WS was 1,014 g in PA and 842 in SO (p-value: 0.09). Duration of surgery was 115 minutes in PA and 122 in SO (p-value: 0.67). Five patients (23%) belonging to PA group developed complications and required SO. Five patients (23%) demised in PA group and six (33%) in SO (p-value: 0.2). Seventeen abdominal reoperations were performed in PA group and 22 in SO group (p-value: 0.08).

Conclusion Both procedures appear to be safe. When possible, PA should be performed as it reduces the number of abdominal reinterventions.

Keywords

focal intestinal perforation - spontaneous intestinal perforation - prematurity - VLBW - primary anastomosis

• References

• 1 Pumberger W, Mayr M, Kohlhauser C, Weninger M. Spontaneous localized intestinal perforation in very-low-birth-weight infants: a distinct clinical entity different from necrotizing enterocolitis. J Am Coll Surg 2002; 195 (06) 796-803
• 2 Singh M, Owen A, Gull S, Morabito A, Bianchi A. Surgery for intestinal perforation in preterm neonates: anastomosis vs stoma. J Pediatr Surg 2006; 41 (04) 725-729 , discussion 725–729
• 3 de Haro Jorge I, Prat Ortells J, Albert Cazalla A, Muñoz Fernández E, Castañón García-Alix M. Long term outcome of preterm infants with isolated intestinal perforation: A comparison between primary anastomosis and ileostomy. J Pediatr Surg 2016; 51 (08) 1251-1254
• 4 Rabe-Hesket A, Skrondal A. Multilevel and Longitudinal Modeling Using Stata, 2nd ed. College Station, Texas: Stata Press; 2008
• 5 Camberos A, Patel K, Applebaum H. Laparotomy in very small premature infants with necrotizing enterocolitis or focal intestinal perforation: postoperative outcome. J Pediatr Surg 2002; 37 (12) 1692-1695
• 6 Hunter CJ, Chokshi N, Ford HR. Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation. J Perinatol 2008; 28 (Suppl. 01) S14-S17
• 7 Moss RL, Dimmitt RA, Barnhart DC. , et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med 2006; 354 (21) 2225-2234
• 8 Hofman FN, Bax NM, van der Zee DC, Kramer WL. Surgery for necrotising enterocolitis: primary anastomosis or enterostomy?. Pediatr Surg Int 2004; 20 (07) 481-483
• 9 Houck CS, Vinson AE. Anaesthetic considerations for surgery in newborns. Arch Dis Child Fetal Neonatal Ed 2017; 102 (04) F359-F363
• 10 Eicher C, Seitz G, Bevot A. , et al. Surgical management of extremely low birth weight infants with neonatal bowel perforation: a single-center experience and a review of the literature. Neonatology 2012; 101 (04) 285-292
• 11 Fisher JG, Jones BA, Gutierrez IM. , et al. Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation: a prospective 5-year multicenter analysis. J Pediatr Surg 2014; 49 (08) 1215-1219