title: Primary anastomosis in necrotizing enterocolitis: the first option to consider.
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) is the most frequent gastrointestinal emergency in preterm newborns. Thirty percent of all cases will require surgical intervention. Following resection of the involved segment, most patients will undergo a diverting enterostomy.
  
  
  OBJECTIVE
  To describe the safety and effectiveness of primary anastomosis in patients with complicated NEC.
  
  
  METHODS
  This study was a retrospective chart review. The study participants were obtained from both public and private health systems between December 2004 and December 2009 in Santiago, Chile. The inclusion criteria were any patient who underwent a laparotomy for necrotizing enterocolitis. The following variables were evaluated: gestational age, birth weight, use of peritoneal drains, macroscopic features of the intestinal segment, number of anastomoses, parenteral nutrition requirements and post-surgical complications.
  
  
  RESULTS
  Seventy patients were identified. Sixty patients (85%) underwent primary anastomosis. The remaining 10 patients underwent a resection with enterostomy. In the primary anastomosis group (n = 60), twelve percent weighed <1,000 g and 22% weighed 1,000-1,500 g. Two anastomoses were required in 18 patients. Post-surgical complications included infection of the surgical wound in three cases and anastomotic dehiscence in only one case. Seven percent developed short bowel syndrome. Overall mortality was 11.6%, all secondary to sepsis.
  
  
  CONCLUSIONS
  In this series, primary anastomosis was a safe alternative in the management of complicated NEC, with low morbidity and mortality, independent of age, weight, intraperitoneal contamination or extent of disease.
authors.affiliation: Exequiel González Cortes Hospital for Children and Clinica Las Condes, Santiago, Chile. mguelfand@clc.cl
authors.forename: Miguel
authors.initials: M
authors.lastname: Guelfand
authors.forename: Marcela
authors.initials: M
authors.lastname: Santos
authors.forename: Maricarmen
authors.initials: M
authors.lastname: Olivos
authors.forename: Alejandra
authors.initials: A
authors.lastname: Ovalle
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D002677:Chile / Q000453:epidemiology; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D007422:Intestines / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D012778:Short Bowel Syndrome / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome