title: Outcomes of diverting jejunostomy for severe necrotizing enterocolitis.
abstract: OBJECTIVE
  A diverting jejunostomy without bowel resection is an option for surgical management of extensive necrotizing enterocolitis (NEC). We aimed to determine outcomes of infants who underwent this operation.
  
  
  METHODS
  We collected clinical and outcome data on infants undergoing a diverting jejunostomy with no bowel resection as a primary procedure for extensive NEC. Data are median (range).
  
  
  RESULTS
  Seventeen neonates underwent a diverting jejunostomy. Eleven (65%) had multifocal disease, whereas 6 (35%) had pan-intestinal involvement. Perforation was seen in 7 (41%), all with multifocal disease. The stoma was placed 12 cm (8-45) from the duodenojejunal flexure. Six infants (35%) died, 4 of these within a day of operation, owing to persisting instability. Intestinal continuity was achieved in all survivors after 52 (17-83) days, and only 1 infant (9%) had a colonic stricture. Seven infants recovered without the need for further intestinal resection distal to the jejunostomy. In those that survived, parenteral nutrition was needed for 2.2 months (1.3-18.0). A single patient had short bowel syndrome.
  
  
  CONCLUSIONS
  A diverting jejunostomy is a useful surgical procedure that allows high survival and enteral autonomy in the treatment of extensive NEC. In most patients, the affected intestine recovers without further intestinal resection.
authors.affiliation: Surgery Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Mandela
authors.initials: M
authors.lastname: Thyoka
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kiely
authors.forename: Joe I
authors.initials: JI
authors.lastname: Curry
authors.forename: David P
authors.initials: DP
authors.lastname: Drake
authors.forename: Kate M K
authors.initials: KM
authors.lastname: Cross
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Hall
authors.forename: A Katy
authors.initials: AK
authors.lastname: Khoo
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D015331:Cohort Studies; D004750:Enteral Nutrition / Q000379:methods; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D007581:Jejunoileal Bypass / Q000379:methods; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome