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Gastrointestinal sequelae after surgery for necrotising enterocolitis: a systematic review and meta-analysis
  1. Eva-Maria Hau1,2,
  2. Sarah C Meyer1,
  3. Steffen Berger1,
  4. Myrofora Goutaki3,4,
  5. Marcin Kordasz1,
  6. Ulf Kessler1,5
  1. 1Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  2. 2Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  3. 3Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
  4. 4Paediatric Respiratory Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
  5. 5Center of Visceral Surgery, Klinik Beau-Site, Hirslanden, Bern, Switzerland
  1. Correspondence to Dr Ulf Kessler, Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern 3012, Switzerland; ulf-kessler{at}hotmail.com

Abstract

Objectives To document what types of gastrointestinal sequelae were described after surgery for necrotising enterocolitis (NEC) and to analyse their frequency.

Design Systematic review and meta-analysis.

Data sources Medline, EMBASE and the Cochrane library (CENTRAL) from 1990 to October 2016.

Eligibility criteria for selecting studies We included studies, which provided original data on the occurrence of gastrointestinal sequelae in patients surviving surgery for NEC. Meta-analysis and metaregression to assess heterogeneity were performed for studies including 10 or more patients with gastrointestinal strictures, recurrence of NEC, intestinal failure (IF) and adhesion ileus.

Results Altogether 58 studies, including 4260 patients, met the inclusion criteria. Strictures were reported to occur in 24% (95% CI 17% to 31%) of surviving patients, recurrence of NEC in 8% (95% CI 3% to 15%), IF in 13% (95% CI 7% to 19%) and adhesion ileus in 6% (95% CI 4% to 9%). Strictures were more common following enterostomy (30%; 95% CI 23% to 37%) than after primary anastomosis (8%; 95% CI 0% to 23%) and occurred more often after enterostomy without bowel resection than with bowel resection. We found considerable heterogeneity in the weighted average frequency of all sequelae (I2 range: 38%–90%). Intestinal outcomes were poorly defined, there were important differences in study populations and designs, and the reported findings bear a substantial risk of bias.

Conclusions Gastrointestinal sequelae in neonates surviving surgery for NEC are frequent. Long-term follow-up assessing defined gastrointestinal outcomes is warranted.

  • sequelae
  • necrotising enterocolitis
  • NEC
  • outcome

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Footnotes

  • E-MH and SCM contributed equally.

  • Contributors EMH and SCM conceptualised and designed the study, drafted the initial manuscript, performed and interpreted the statistical analysis, were part of the writing committee, and critically reviewed and revised the manuscript. SB, MG and MK partially performed and interpreted the statistical analysis, were part of the writing committee and critically reviewed the manuscript. UK conceptualised and designed the study, drafted the initial manuscript, together with EMH and SCM, interpreted the data, was part of the writing committee, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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