Salvage laparotomy for failure of peritoneal drainage in necrotizing enterocolitis in infants with extremely low birth weight

Background/Purpose: Peritoneal drainage is a temporizing procedure for infa nts with extremely low birth weight (ELBW) who have perforated necrotizing enterocolitis (NEC). "Salvage" laparotomy is advocated when patients worsen after drainage. Some patients have survived with intact gastrointestinal f unctional after drainage alone. The purpose of this study is to determine i f these salvage laparotomies are beneficial. Methods: The authors reviewed the records of ELBW infants treated at Stanfo rd University with perforated NEC from 1993 through 1998. Data collected in cluded demographic makeup, type of operation, survival rate, postoperative complications, length of stay (LOS), and cost. Results: The authors treated 26 patients, 9 with laparotomy and 17 with per itoneal drainage. The peritoneal drainage group had lower birth weight and more comorbid conditions. Survival rate was similar between laparotomy and drainage: 55.6% versus 41.2%. Four patients in the drainage group underwent salvage laparotomy for perceived clinical deterioration. All of these pati ents died. The clinical status of patients who had salvage laparotomy and d ied was similar to those who did not and lived. Seven of 13 patients treate d with drainage followed only by supportive care and antibiotics survived. Cost and LOS for patients undergoing salvage laparotomy were much greater t han for nonsurviving patients undergoing only peritoneal drainage: 84 +/- 2 0 days and $660,000 compared with 34 +/- 11 days and $306,000. Conclusions: Both primary peritoneal drainage and laparotomy should be cons idered primary therapy for perforated NEC. Patients undergoing peritoneal d rainage typically experience clinical deterioration after operation. in thi s limited experience, salvage laparotomy did not appear beneficial. Copyrig ht (C) 2000 by W.B. Saunders Company.