Drenaje peritoneal versus laparotomía como abordaje para enterocolitis necrosante perforada en recién nacidos pretérmino de bajo peso / Peritoneal drainage versus laparotomy for perforated necrotizing enterocolitis in preterm low birth weight infants

Resumen El desarrollo de enterocolitis necrosante, con la consecuente perforación intestinal, es frecuente en los recién nacidos pretérmino. El tratamiento estándar de la perforación intestinal es quirúrgico. Sin embargo, se sugiere que la inserción de un drenaje en el abdomen puede ser efectivo para tratar esta afección. Se resumen los resultados de una revisión sistemática Cochrane que compara la efectividad del drenaje peritoneal con la de la laparotomía en neonatos con enterocolitis necrosante perforada.

Abstract Necrotizing enterocolitis is common in preterm newborns, with consequent intestinal perforation. The standard treatment for intestinal perforation is surgery. However, it is suggested that inserting a drain into the abdomen may be effective in treating this condition. This document summarizes the results of a Cochrane systematic review comparing the effectiveness of peritoneal drainage with laparotomy in neonates with perforated necrotizing enterocolitis.

Primary peritoneal drainage in neonates with necrotizing enterocolitis associated with congenital heart disease: a single experience in a Brazilian tertiary center

Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.

Usefulness of peritoneal drainage in extremely low birth weight infants with intestinal perforation: a single-center experience

PURPOSE: Necrotizing enterocolitis and intestinal perforation are the most common surgical emergency in the neonatal intensive care unit. The purpose of this study is to evaluate if peritoneal drainage (PD) is beneficial in extremely low birth weight infants with intestinal perforation.METHODS: Retrospective cohort study of extremely low birth weight infants with a diagnosis of intestinal perforation. They were received primary PD (n = 23, PD group) or laparotomy (n = 13, LAP group). Laboratory and physiologic data were collected and organ failure scores calculated and compared between preprocedure and postprocedures. Data were analyzed using appropriated statistical tests.RESULTS: Between January 2005 and December 2015, 13 infants (male:female = 9:4) received laparotomy. Of 23 infants (male:female = 16:7) received PD, 20 infants received subsequent laparotomy. There were no demographic differences between PD and LAP groups. And there were no differences in total organ score in either group (PD, P = 0.486; LAP, P = 0.115). However, in LAP group, respiratory score was statistically improved between pre- and postprocedure organ failure score (P = 0.02). In physiologic parameter, PD group had a statistically worsening inotropics requirement (P = 0.025). On the other hand, LAP group had a improvement of PaO₂/FiO₂ ratio (P = 0.01).CONCLUSION: PD does not improve clinical status in extremely low birth weight infants with intestinal perforation.

Enclosed passive infraversion lavage-drainage system / 中华肝胆外科杂志

This study gave a detailed explanation of the mechanism and method for the application of the enclosed passive infraversion lavage drainage system.In this drainage system,the rinse solution was infused into the peritoneal cavity passively rather than actively.This guarantees that the output of the solution was more than the input of the solution.It is also a safe and effective system in washing severe bile leakage and pancreatic fistula in the early stage after pancreatoduodenectomy.

Prevention and Treatment of Necrotizing Enterocolitis / 한양의대학술지

Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality among premature infants. Although the pathogenesis of NEC remains unclear, recent researches revealed several associated factors of the immature intestine, with an emphasis of delayed maturation of motor and digestive function, impairment of regulation of vascular flow and intestinal barrier function, and defective immune defense. Many clinical trials have investigated the preventive role of possible disease-modification factors, but only breast feeding and antenatal steroid were proven to decrease the incidence of NEC in meta- analyses. Recent multicenter studies demonstrated a promising outcome of probiotics supplementation in the prevention of NEC, which emphasized the role of abnormal bacterial colonization in the pathogenesis of NEC. Studies on optimal choice for surgically indicated infants with NEC (laparatomy versus primary peritoneal drainage) still remain inconclusive. As NEC is a disease with a multifactorial etiology, combinations of current evidence in practice are required to reduce the incidence of NEC.

Clinical experience of therapeutic effect of peritoneal drainage on intestinal perforation in preterm infants / 소아과

PURPOSE: To analyze and compare various cases in which peritoneal drainage was used as the primary treatment method in preterm infants with intestinal perforation. METHODS: Among the preterm infants of less than 28 weeks of gestation who were admitted to the neonatal intensive care unit (NICU) at the Gangnam Severance Hospital from April 2006 to April 2009, 7 who had developed intestinal perforation were studied retrospectively. We investigated the clinical characteristics, secondary operation performances, morbidities, complications, and mortalities. RESULTS: Among the 7 infants, 5 survived. Of the 5 cases, 3 received laparotomy, of which 2 were confirmed as having necrotizing enterocolitis. Of the 2 infants who died, 1 had received laparotomy before 48 h of peritoneal drainage, while the other had not received any subsequent treatment. Of the 7 children, 4 had patent ductus arteriosus (PDA), of which 3 had received indomethacin injection. Five infants had begun enteral feeding before they developed intestinal perforation. Of the 5 infants who survived, 4 were diagnosed with cholestasis. Of the 7 infants, 4 developed periventricular leukomalacia (PVL) and 3 developed rickets. CONCLUSION: Although the use of peritoneal drainage as the primary management of intestinal perforation in preterm infants is controversial, we suggest that it can be used for treating extreme premature neonates. Further randomized controlled study will be required to determine the feasibility of using this method.

Clinical experience of therapeutic effect of peritoneal drainage on intestinal perforation in preterm infants / 소아과

PURPOSE: To analyze and compare various cases in which peritoneal drainage was used as the primary treatment method in preterm infants with intestinal perforation. METHODS: Among the preterm infants of less than 28 weeks of gestation who were admitted to the neonatal intensive care unit (NICU) at the Gangnam Severance Hospital from April 2006 to April 2009, 7 who had developed intestinal perforation were studied retrospectively. We investigated the clinical characteristics, secondary operation performances, morbidities, complications, and mortalities. RESULTS: Among the 7 infants, 5 survived. Of the 5 cases, 3 received laparotomy, of which 2 were confirmed as having necrotizing enterocolitis. Of the 2 infants who died, 1 had received laparotomy before 48 h of peritoneal drainage, while the other had not received any subsequent treatment. Of the 7 children, 4 had patent ductus arteriosus (PDA), of which 3 had received indomethacin injection. Five infants had begun enteral feeding before they developed intestinal perforation. Of the 5 infants who survived, 4 were diagnosed with cholestasis. Of the 7 infants, 4 developed periventricular leukomalacia (PVL) and 3 developed rickets. CONCLUSION: Although the use of peritoneal drainage as the primary management of intestinal perforation in preterm infants is controversial, we suggest that it can be used for treating extreme premature neonates. Further randomized controlled study will be required to determine the feasibility of using this method.

Experience with Peritoneal Drainage in Extremely Low-birth-weight Infants

Recently, the survival rates of extremely low-birth-weight (ELBW) infants have improved with the development of neonatal intensive care. However, these infants were susceptible to intestinal perforation due to prematurity, fluid restriction, and injection of indomethacin, etc. Because of the risks of transportation, anesthesia and surgery itself, peritoneal drainage has been compared with laparotomy. Through our experience, we investigate the usefulness of peritoneal drainage retrospectively. From 1997 to 2007, six ELBW (M:F=5:1) underwent primary peritoneal drainage for intestinal perforation. Their median birth weight was 685 g (405~870) and gestational age was 25(+1) weeks (24(+3)~27(+0)). We noticed the intestinal perforation at median 10.5 days (8~18) after birth, and placed Penrose drain or Jackson-Pratt drain through right lower quadrant incision under local anesthesia. The cause of intestinal perforation was necrotizing enterocolitis in one patient, but that of the others was not clear. Three patients who showed normal platelet count and stable vital signs recovered uneventfully. Two patients (birth weight less than 500 g) who showed unstable vital signs and low platelet count (12,000 / mm3 to 30,000 / mm3) expired despite aggressive resuscitation. One patient required laparotomy due to persistent intestinal obstruction after drain removal and survived. Our experience shows that peritoneal drainage was an acceptable treatment for ELBW infants and the prognosis was related to vital sign and platelet count at the time of intestinal perforation, and birth weight.

Assessment of Peritoneal Irrigation and Drainage by Perioperative Leukocyte Count following Gastric Cancer Surgery

PURPOSE: There has been debate on the use of peritoneal irrigation and drainage following gastric cancer surgery. This study was conducted to evaluate the usefulness of routine peritoneal irrigation and drainage following gastric cancer surgery, especially with regard to the perioperative leukocyte count. METHODS: Of 298 patients, 153 were enrolled in the test group (without peritoneal irrigation & drainage), between October 2001 and August 2002, and 145 in the control group (with peritoneal irrigation and drainage), between January 2001 and September 2001. The demographics, range of dissection, pathological staging, operation times, anesthesia times, fever, perioperative leukocyte counts and operative complications were retrospectively analyzed in these consecutive patients. RESULTS: It was found that there was no difference in the demographics, range of dissection, pathological staging and operative complications between the two groups. However, the operation times, anesthesia times, and mean length of hospitalization in the test group were significantly shorter than those in the control group. No significance differences were found between the two groups with regard to the perioperative leukocyte counts. CONCLUSION: The routine usage of peritoneal irrigation and drainage was found to be neither safe nor effective in gastric cancer surgery patients.

Assessment of Peritoneal Irrigation and Drainage Following Elective Gastric Cancer Surgery

PURPOSE: Peritoneal irrigation and drain insertion were traditionally performed following major abdominal surgery, as routine procedures The aim of this retrospective study was to evaluate the usefulness of peritoneal irrigation and drain insertion following elective gastric cancer surgery. METHODS: Between December 2000 and Feburary 2002, 184 patients having undergone surgery for gastric cancer were divided into two groups, a comparative group (86 patients with peritoneal irrigation and drainage) and an experimental group (98 patient without peritoneal irrigation and drainage). The demographics, histopathological classification, range of dissection, comorbid disease, first passage of flatus, start of soft diet, operation time, anesthesia time and operative complication were analyzed retrospectively in consecutive patients. The data were analyzed by student's t-tests with the level of significance set at P<0.05. RESULTS: No significance differences were found between the two groups in regard to demographics, range of dissection, comorbid disease or complications. However the mean length of hospitalization, operation time and anesthesia time and the first passage of flatus, and start of soft diet in the experimental group were significantly shorter than those in the comparative group. CONCLUSION: The result shows that routine peritoneal irrigation and drain insertion following elective gastric cancer surgery are ineffective in reducing postoperative complications. We think these procedures are unnecessary and offer no considerable advantages.

A Case of Gallbladder Perforation Treated By Percutaneous Transhepatic Cholecystic Drainage and Percutaneous Peritoneal Drainage / 대한소화기내시경학회지

Perforation of gallbladder is a serious complication of acute cholecystitis with alarmingly high mortality rate. These high mortality and morbidity rates were caused by delay in prompt diagnosis and adequate therapy. Especially, mortality and morbidity rates rise markedly in the elderly patient with severe systemic illness. In the patients of gallbladder perforation who are poor candidate for general anesthesia and major operation, percutaneous cholecystic drainage procedure is good alternatives. We experienced a case of gallbladder perforation which was treated successfully by non-operative percutaneous transhepatic cholecystic drainage(PTCCD) in 65-year-old female. She couldn't be a candidate for cholecystectomy or operative chlecystostomy because of severe adhesion of gallbladder to adjacent organ and tissue due to previous gallbladder empyema. We decided to take non-operative percutaneous transhepatic cholecystic drainage and percutaneous peritoneal drainage of abdominal abscess. Thereafter, we examined gallbladder by percutaneous transhepatic cholecystoscopylPTCCS)and rule out gallstone and gallbladder malignancy. So, we presented the case with the brief review of the literatures.