Original Article

Hernia

, Volume 18, Issue 3, pp 351-356

First online:

Postoperative outcome in premature infants with open abdomen

  • A. LambertzAffiliated withDepartment of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital Email author 
  • , M. BinneböselAffiliated withDepartment of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital
  • , A. RöthAffiliated withDepartment of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital
  • , T. OrlikowskyAffiliated withNeonatology Section, Department of Paediatric and Adolescent Medicine, RWTH Aachen University Hospital
  • , U. P. NeumannAffiliated withDepartment of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital
  • , G. SteinauAffiliated withDepartment of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital
  • , C. D. KlinkAffiliated withDepartment of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital

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Abstract

Background

Premature infants treated with laparostomy in the first days of their life represent a group of complex patients with high morbidity and mortality rates. Laparostomy is a surgical treatment method in which the peritoneal cavity is opened anteriorly and deliberately left open, hence often called “open abdomen”. The aim of this study was to analyze crucial factors influencing the postoperative outcome of premature infants treated this way.

Methods

Between March 2002 and August 2012, we treated 40 premature infants with a median gestational age of 29 weeks (range from 24 to 34 weeks) with open abdomen in our institution. Their data were analyzed retrospectively. They were divided into two groups depending on in-hospital survival.

Results

Indications for surgery were ileus (n = 16), spontaneous intestinal perforation (n = 11), gastroschisis (n = 8) and necrotizing enterocolitis (NEC, n = 5). The overall in-hospital mortality was 43 % (17 of 40 patients). Postoperative anemia was the only significant factor influencing mortality rates in our patients (10 vs. 14 patients; p = 0.028). Neither the indication of surgery, nor week of gestation, nor birth weight had any significant influence on postoperative survival. Twenty-one of the 23 surviving patients reached fascia closure.

Conclusions

In our study, outcome of premature infants with open abdomen in the first days of their life seems to depend more on an operation and a postoperative course without complications than on the preoperative conditions of the children. Postoperative anemia seems to be a significant negative prognostic marker. Patients reaching fascia closure mainly survive.

Keywords

Premature infants Open abdomen Mortality Postoperative outcome Fascia closure