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Resection and Primary Anastomosis Is a Valid Surgical Option for Infants With Necrotizing Enterocolitis Who Weigh Less Than 1000 g
N. J. Hall, MD;
J. Curry, MD;
D. P. Drake, MD;
L. Spitz, PhD;
E. M. Kiely, MD;
A. Pierro, MD
Arch Surg. 2005;140:1149-1151.
Hypothesis Primary anastomosis following intestinal resection is a valid surgical option in the treatment of infants with necrotizing enterocolitis (NEC) who weigh less than 1000 g.
Design Retrospective case series.
Setting Tertiary neonatal surgery referral center.
Patients All infants with confirmed NEC weighing less than 1000 g admitted to our intensive care unit over 4 years.
Intervention For infants requiring laparotomy and intestinal resection, primary anastomosis was performed whenever the clinical condition permitted.
Main Outcome Measures Short- and long-term survival, length of intensive care unit stay, and complications.
Results Fifty-one infants with NEC who weighed less than 1000 g were admitted during the study period. Twelve infants underwent intestinal resection and primary anastomosis (median weight at surgery, 0.83 kg; range, 0.6-0.96 kg). One infant developed recurrent NEC, requiring further surgery, but there were no anastomotic leakages and no strictures. The median postoperative stay on our intensive care unit was 14 days (range, 2-49 days). All 12 infants survived their episode of acute NEC, and 8 are alive, with a median follow-up of 34.2 months (range, 4.7-48.4 months). Only 1 death was related to NEC. During the same period, 14 infants underwent intestinal resection and stoma formation. Ten survived the acute episode, and 6 are alive at a median follow-up of 24.0 months (range, 13.1-33.9 months). The median postoperative intensive care unit stay was 18 days (range, 2-74 days). Necrotizing enterocolitis–related complications occurred in 8 of these infants.
Conclusions The outcome of infants with NEC who weigh less than 1000 g and undergo primary anastomosis is comparable to that of infants treated using alternative techniques. It is, therefore, a valid surgical option in selected infants. The mortality in this group of infants is high.
Author Affiliations: Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital, London, England.
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