Primary laparotomy is effective and safe in the treatment of necrotizing enterocolitis.
BACKGROUND
There is ongoing controversy regarding the surgical treatment of necrotizing enterocolitis (NEC) in infants with extremely low birth weight (ELBW). We hypothesize that primary laparotomy is a safe and effective treatment for all infants with surgical NEC.


METHODS
We retrospectively compared a group of ELBW infants (<1,000 g, group A, n = 39) with preterm infants (≥1,000 g, group B, n = 18) with surgical NEC during a 4-year period (10/2008-09/2012). Indications for emergency operation were Bell stages IIIa or IIIb. The main outcome measure was survival. Data were analyzed using Chi squared test and Spearman's rank correlation coefficient.


RESULTS
Fifty-seven patients were included with a gestational age from 24 to 30 weeks in group A and 27-38 weeks in group B. There were no significant differences in Bell stage (IIIa; IIIb) and NEC type (focal; segmental; pannecrosis). The operative techniques were not significantly different between the groups and included resection and stoma formation in 44 of 57 (77 %) patients; resection and anastomosis in 6 of 57 (11 %); and inspection only, followed by withdrawal of care, in 7 of 57 (12 %). Overall mortality was 10 of 57 (17 %) with no significant difference between the groups. The only significant correlation was observed between the length of necrotic bowel and mortality. In total, 7 of 57 infants required repeated surgery after initial treatment. We observed stoma complications in 36 % of the patients in group A and 21 % in group B without the need of stoma revision. All stomas were successfully closed at the time of the study. One of 44 patients with stoma closure required a relaparotomy due to bowel obstruction.


CONCLUSIONS
Early primary laparotomy is safe and effective for the management of surgical NEC in ELBW infants. Outcome of affected infants is not influenced by age or weight at surgery but by the length of necrotic bowel.
Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt/M., Theodor-Stern-Kai 7, 60590, Frankfurt, Germany, stefan.gfroerer@kgu.de.
Stefan
S
Gfroerer
Henning
H
Fiegel
Rolf L
RL
Schloesser
Udo
U
Rolle
D001724:Birth Weight; D020345:Enterocolitis, Necrotizing / Q000401:mortality* / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D012189:Retrospective Studies; D012720:Severity of Illness Index; D054047:Surgical Stomas / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome