Surgery for intestinal perforation in preterm neonates: anastomosis vs stoma.
BACKGROUND
Traditionally, a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC). We compared the outcome of resection and anastomosis (RA) with stoma formation (RS).


METHODS
Sixty-eight neonates undergoing laparotomy for IIP (n = 20), NEC (n = 43), and indeterminate cause (n = 5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis- and stoma-related complications.


RESULTS
The median gestational age (GA) was 28.5 weeks and birth weight (BW) was 940 g. Thirty-seven neonates had RA (NEC 22, IIP 14, 1 unknown), 28 RS (NEC 21, IIP 6, 1 unknown), and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean +/- SD GA of those who survived was 30 +/- 4.5 weeks and those who died was 27.2 +/- 3.5 weeks (P = .008). The mean BW for those that survived was 1440.5 +/- 865.1 g and those who died was 827.7 +/- 385.1 g (P = .002). There was no statistically significant difference between the RA and RS groups for GA (P = .93), BW (P = .4), general complications (P = .96), anastomosis and stoma complications (P = .48), and deaths (P = .42).


CONCLUSIONS
RA, rather than stoma, is an acceptable option in the surgical management of preterm neonates with IIP or NEC.
Neonatal Surgical Unit, St Mary's Hospital, Manchester M13 0JH, UK.
Michael
M
Singh
Anthony
A
Owen
Sobbia
S
Gull
Antonino
A
Morabito
Adrian
A
Bianchi
D000714:Anastomosis, Surgical; D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007416:Intestinal Perforation / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas