Primary anastomosis in necrotizing enterocolitis: the first option to consider

Area of Science:

• Neonatal Surgery
• Gastrointestinal Surgery
• Pediatric Gastroenterology

Background:

• Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency in preterm infants.
• Surgical intervention is required in 30% of NEC cases, often necessitating a diverting enterostomy after bowel resection.

Purpose of the Study:

• To evaluate the safety and efficacy of primary anastomosis in neonates with complicated NEC.
• To compare outcomes of primary anastomosis versus traditional enterostomy in NEC management.

Main Methods:

• Retrospective chart review of patients undergoing laparotomy for NEC between 2004 and 2009 in Santiago, Chile.
• Analysis of variables including gestational age, birth weight, surgical approach, and post-operative complications.

Main Results:

• Primary anastomosis was performed in 85% (60/70) of patients with complicated NEC.
• The primary anastomosis group experienced low complication rates, including surgical wound infection (5%) and anastomotic dehiscence (1.7%).
• Overall mortality was 11.6%, primarily due to sepsis, with primary anastomosis demonstrating favorable outcomes regardless of patient factors.

Conclusions:

• Primary anastomosis is a safe and effective surgical strategy for complicated NEC in neonates.
• This approach is associated with low morbidity and mortality, proving independent of patient age, weight, or disease severity.
• Primary anastomosis presents a valuable alternative to diverting enterostomy in the surgical management of NEC.