title: Long term outcome of preterm infants with isolated intestinal perforation: A comparison between primary anastomosis and ileostomy.
abstract: OBJECTIVE
  Management of isolated intestinal perforation (IIP) poses a challenge for the pediatric surgeon. Intestinal resection and primary anastomosis is considered to be as good as the classical approach, namely, intestinal diversion by ileostomy. However, few reports compare primary anastomosis and ileostomy as IIP treatment. In our institution we favored primary anastomosis as first line treatment whenever patient's condition permitted. Our purpose is to retrospectively compare the outcomes of preterm infants treated with primary anastomosis or ileostomy during a laparotomy in which an IIP was found.
  
  
  METHODS
  We identified all newborns who had abdominal operations for IIP from 2000 through 2013. Patients with extensive necrotizing entorocolitis and comorbidities were excluded, as well as those who died in the first 24h. Demographics, type of treatment and complications were reviewed. Major complications included the need for an urgent reoperation, development of late NEC and death.
  
  
  RESULTS
  Twenty-three patients with a median gestational age (GA) of 27weeks and median birth weight (BW) of 883g had receive two types of treatment: group I included 9 patients who had intestinal resection of the affected bowel and ileostomy; group PA consisted of 14 patients who had intestinal resection and primary anastomosis. The decision to perform PA or I was based on the surgeon's judgment, in the absence of a specific protocol. There were no significant differences in GA and BW between both groups. Overall mortality was 30.4%. However mortality was restricted to group PA (n=7 cases; 50%) (p=0.019). Most major complications occurred in group PA (71% vs. 11%, p=0.029). There were six cases of late NEC, all in group PA (p=0.048), and four of those patients died. Other than the type of treatment, no differences could be identified between both groups.
  
  
  CONCLUSIONS
  Preterm newborns with IIP are at a higher risk for developing life-threatening complications if treated with primary anastomosis than with ileostomy.
authors.affiliation: Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona; Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona.
authors.forename: Irene
authors.initials: I
authors.lastname: de Haro Jorge
authors.affiliation: Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona; Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona. Electronic address: joprat@hsjdbcn.org.
authors.forename: Jordi
authors.initials: J
authors.lastname: Prat Ortells
authors.affiliation: Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona; Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona.
authors.forename: Asteria
authors.initials: A
authors.lastname: Albert Cazalla
authors.affiliation: Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona; Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona.
authors.forename: Elena
authors.initials: E
authors.lastname: Muñoz Fernández
authors.affiliation: Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona; Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Castañón García-Alix
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007416:Intestinal Perforation / Q000601:surgery*; D007813:Laparotomy; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Anastomosis; Ileostomy; Intestinal perforation; Premature