Letter to the Editor in Response to: Early Laparoscopic-Assisted Surgery is Associated with Decreased Post-Operative Inflammation and Intestinal Strictures in Infants with Necrotizing Enterocolitis.

We read with interest your recent article by Montalva et al., and the invited commentary by Zani reporting and discussing the use of laparoscopy in necrotizing enterocolitis (NEC) [ [1] Montalva L. Incerti F. Qoshe L. Haffreingue A. Marsac L. Frérot A. et al. Early laparoscopic-assisted surgery is associated with decreased post-operative inflammation and intestinal strictures in infants with necrotizing enterocolitis. J Pediatr Surg. 2022; https://doi.org/10.1016/j.jpedsurg.2022.11.007 Abstract Full Text Full Text PDF Scopus (2) Google Scholar , [2] Zani A. 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. J Pediatr Surg. 2022; https://doi.org/10.1016/j.jpedsurg.2022.11.019 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ]. We would like to draw readers’ attention to an additional, and we believe important, difference between groups in this study, which is only briefly mentioned in either the authors' original discussion or the invited commentary. The authors propose that with a new treatment pathway comprising initial diagnostic laparoscopy, there is less inflammation and reduced stricture rate in infants with NEC. They attribute this benefit to the use of initial laparoscopy (citing CO2 pneumoperitoneum as being anti-inflammatory) despite the fact that 90% of cases subsequently went on to have laparotomy.