Surgical treatment of necrotizing enterocolitis: when? how?
In 10 years (1981-1990) 28 out of 54 neonates (51.8%) with definite necrotizing enterocolitis (NEC) underwent surgery. Operation was performed at 13.5 +/- 8.8 (range 3-38) days of life, after 1.7 +/- 1.5 (range 1-6) days from the onset of symptoms. Aiming to perform laparotomy before the occurrence of perforation, surgery was liberally indicated in stage IIIa, according to Walsh-Kliegman. Explorative laparotomy (+peritoneal drainage in 2 cases) was performed in 4 patients with massive intestinal necrosis: all died within 3 days of surgery. In one neonate, only pneumatosis was present and resection was not considered mandatory. Intestinal resection and enterostomy was performed in 17 neonates, 5 of them with perforation; three developed an intestinal stenosis. Enterostomy was closed after 116.2 +/- 61.8 days (range 26-193); 11 patients (64.7%) are long-term survivors. Intestinal resection and primary anastomosis was performed in 6 babies, 3 of them with perforation. Postoperatively, 2 dehiscences and 1 stenosis were recorded, but all children survived. In our opinion, resection followed by primary anastomosis seems to be the most satisfactory surgical option.
Parigi
G B
GB
Chirurgia Pediatrica, Università degli Studi, Pavia, Italy.
Bragheri
R
R
Minniti
S
S
Verga
G
G
D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery; D004761:Enterocolitis, Pseudomembranous / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004766:Enterostomy; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D007813:Laparotomy; D008297:Male; D010533:Peritoneal Lavage; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome