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Primary anastomosis as a valid alternative for extremely low birth weight infants with spontaneous intestinal

Martin Dübbers1, Gerd Holtkamp2, Grigore Cernaianu2

  • 1Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany. martin.duebbers@uk-koeln.de.

European Journal of Pediatrics
|January 13, 2021
PubMed

Insights

Primary anastomosis (PA) is a viable surgical option for infants with spontaneous intestinal perforation (SIP) weighing under 1000g. This approach shows comparable mortality and reoperation rates to enterostomy (ES), with potential benefits in weight gain and shorter hospital stays.

Area of Science:

  • Neonatal surgery
  • Pediatric surgery
  • Gastrointestinal surgery

Background:

  • Spontaneous intestinal perforation (SIP) is a critical condition in extremely low birth weight (ELBW) infants.
  • Surgical management options include enterostomy (ES) and primary anastomosis (PA).
  • Stomal complications and failure to thrive are significant concerns with ES.

Purpose of the Study:

  • To compare the outcomes of primary anastomosis (PA) versus enterostomy (ES) in infants with spontaneous intestinal perforation (SIP) weighing less than 1000 grams.
  • To evaluate mortality, reoperation rates, length of hospital stay, and weight gain between the two surgical approaches.

Main Methods:

  • Retrospective cohort study comparing infants with SIP <1000g treated with PA versus ES.
  • Data collected from 2014-2019, analyzing outcomes including mortality, reoperations, length of stay, and discharge weight.
  • Forty-two infants were included: 30 in the PA group and 12 in the ES group.

Main Results:

  • Overall in-hospital mortality was 11.9% (PA: 13.3%, ES: 8.3%).
  • Reoperations were needed in 10/30 PA patients and 4/12 ES patients.
  • Median weight at discharge was significantly higher in the PA group (2258g) compared to the ES group (1880g).
  • Length of stay was comparable: 110.5 days for PA and 124 days for ES.

Conclusions:

  • Primary anastomosis (PA) is a feasible and safe treatment for SIP in infants <1000g.
  • PA demonstrates comparable mortality and revision rates to ES.
  • PA may lead to improved weight gain and potentially shorter hospitalizations, warranting further investigation into patient selection criteria.

Keywords:
ELBWExtremely low birth weightFocal intestinal perforationPrimary anastomosisSpontaneous intestinal perforation

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