Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation.
BACKGROUND
Necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) are neonatal intestinal emergencies that affect premature infants. Although most cases of early NEC can be successfully managed with medical therapy, prompt surgical intervention is often required for advanced or perforated NEC and FIP.


METHODS
The surgical management and treatment of FIP and NEC are discussed on the basis of literature review and our personal experience.


RESULTS
Surgical options are diverse, and include peritoneal drainage, laparotomy with diverting ostomy alone, laparotomy with intestinal resection and primary anastomosis or stoma creation, with or without second-look procedures.


CONCLUSIONS
The optimal surgical therapy for FIP and NEC begins with prompt diagnosis and adequate fluid resuscitation. It appears that there is no significant difference in patient outcome based on surgical management alone. However, the infant's weight, comorbidities, surgeon preference and timing of intervention should be taken into account before operative intervention.
Hunter
C J
CJ
Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Chokshi
N
N
Ford
H R
HR
D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019317:Evidence-Based Medicine; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D007416:Intestinal Perforation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011361:Professional Competence; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation; D015996:Survival Rate