Invited commentary on Montalva L, et al.: Early laparoscopic-assisted surgery is associated with decreased post-operative inflammation and intestinal strictures in infants with necrotizing enterocolitis

Abstract

In this retrospective study, Montalva L, et al, investigated the role of laparoscopy in infants with necrotizing enterocolitis (NEC). NEC remains a devastating disease that affects premature babies, is still burdened by high morbidity and mortality rates, and is currently considered as the most frequent cause for urgent laparotomy in neonates [ 1 Jones I.H. Hall N.J. Contemporary Outcomes for Infants with Necrotizing Enterocolitis-A Systematic Review. J Pediatr. 2020; 220: 86-92 Google Scholar , 2 Matei A. Montalva L. Goodbaum A. et al. Neurodevelopmental impairment in necrotising enterocolitis survivors: Systematic review and meta-analysis. Arch Dis Child Fetal Neonatal. 2020; 105: 432-439 Google Scholar ]. Classically, babies that are deemed candidates for surgery undergo open surgery, with the primary goal of resecting the necrotic bowel and creating a diverting ostomy and/or a primary anastomosis. Alternatives to laparotomy include the intraperitoneal drain insertion, whose role remains controversial after at least three randomized controlled trials, and laparoscopy. The use of the latter in premature babies with NEC was initially reported in 2004 as a diagnostic tool to confirm bowel necrosis [ 3 Pierro A. Hall N. Ade-Ajayi A. et al. Laparoscopy assists surgical decision making in infants with necrotizing enterocolitis. J Pediatr Surg. 2004; 39: 902-906 Google Scholar ]. Since then, laparoscopic surgery for NEC has gained popularity, with some twenty studies published in the literature.