Surgery for necrotising enterocolitis: primary anastomosis or enterostomy?
The ideal surgical management of neonates with necrotising enterocolitis (NEC) is still a matter of debate. The purpose of this study was to compare the results of bowel resection with primary anastomosis with the results of bowel resection with enterostomy. Sixty-three neonates with NEC had a bowel resection in the acute phase of the disease in the period between February 1990 and March 2001. Thirty-four of them (54%) underwent resection of the bowel with primary anastomosis (Group A), and 29 (46%) had resection with enterostomy (Group B). Group A had a lower gestational age and lower birth weight. Mortality, complication rate, and postoperative weight gain were not significantly different between the groups. However, Group B had a significantly longer primary hospital stay (80 +/- 49 days versus 58 +/- 31 days, P < 0.04) and needed a 2nd hospital stay for restoring gastrointestinal continuity. For both reasons, it can be argued that primary anastomosis is superior to enterostomy after resection.
Hofman
F N
FN
Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
Bax
N M A
NM
van der Zee
D C
DC
Kramer
W L M
WL
D000714:Anastomosis, Surgical / Q000009:adverse effects; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D004766:Enterostomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery*; D007422:Intestines / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D010289:Parenteral Nutrition, Total; D010359:Patient Readmission; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D015430:Weight Gain