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Resection with primary anastomosis for necrotizing enterocolitis: a contrasting view
A Cooper1, A J Ross, J A O'Neill
1Department of Surgery, Babies' Hospital, Columbia-Presbyterian Medical Center, New York, NY 10032.
Insights
Primary anastomosis for necrotizing enterocolitis in infants showed lower survival (48%) compared to resection with enterostomy (72%). This retrospective study suggests enterostomy may be safer for surgical necrotizing enterocolitis treatment.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastrointestinal Surgery
Background:
- Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency in neonates.
- Surgical management is often required for advanced NEC.
- Primary anastomosis is increasingly advocated for NEC resection.
Purpose of the Study:
- To evaluate the efficacy and outcomes of primary anastomosis versus resection with enterostomy in infants with surgical NEC.
- To compare survival rates between different surgical approaches for NEC.
Main Methods:
- Retrospective review of 173 infants with advanced NEC treated since 1974.
- Analysis of outcomes for patients undergoing resection with primary anastomosis versus resection with enterostomy.
- Exclusion of patients with late stricture repair.
Main Results:
- Overall survival for resected NEC was 65% (96/143).
- Survival was lower with primary anastomosis (48%, 13/27) compared to enterostomy (72%, 83/116).
- Excluding early years (1974-1976), survival improved to 77% overall, with 64% for primary anastomosis.
Conclusions:
- Resection with enterostomy demonstrated a higher survival rate than primary anastomosis in this cohort of infants with surgical NEC.
- The findings question the routine use of primary anastomosis for NEC, suggesting enterostomy may be a safer initial approach.
- Further investigation into optimal surgical strategies for NEC is warranted.
Abstract:
Resection with primary anastomosis is currently being advocated for treatment of infants with necrotizing enterocolitis. To determine whether our own data would support such an approach, we reviewed retrospectively our experience with this disease since 1974. Since that time, 173 infants have been admitted for treatment of advanced (surgical) disease in its acute phase, of whom 143 underwent resection for cure; the remainder either underwent laparotomy with decompression (3), laparotomy with drainage (3), laparotomy alone (14), died at operation (1), or could not be resuscitated sufficiently to withstand operation (9). Excluded were patients who underwent operative repair of late stricture (6), all of whom survived with no morbidity. Among those resected for cure, 27 infants were carefully selected by the operating surgeon for treatment by means of resection with primary anastomosis, based on the limited and apparently discrete nature of their disease; in three the procedure was combined with a decompressing enterostomy. In the majority of cases (14), the disease was found to involve multiple areas of intestine, but was limited to a particular anatomic region, usually distal ileum and/or ascending colon; in the remainder, it was due to discrete ileal or jejunal perforation or ulcer. Overall survival among those resected for cure was 65% (96/143). It was 48% (13/27) among those treated by means of resection with primary anastomosis but 72% (83/116) among those who underwent resection with enterostomy. However, if the early years of the series (1974 to 1976) are excluded, a time when resection with enterostomy had not yet become established as standard therapy, overall survival was 77% (77/100), 64% (9/14) among those anastomosed primarily.