Primary Anastomosis Valid for Infants with Enterocolitis
Outcome compares well with other treatments but mortality rate still high
WEDNESDAY, Dec. 21 (HealthDay News) -- Infants who weigh less than 1,000 grams and have necrotizing enterocolitis (NEC) have similar outcomes whether they are treated with resection and primary anastomosis or with stoma formation, according to a study in the December issue of the Archives of Surgery. However, mortality in these patients is high, regardless of treatment, the authors say.
N.J. Hall, M.D., of Great Ormond Street Hospital in London, U.K., and colleagues analyzed 51 cases of NEC in infants weighing less than 1,000 g admitted to the hospital's intensive care unit over a period of four years. For 12 infants whose clinical condition permitted, primary anastomosis was performed when they required laparotomy and intestinal resection.
Although one case developed recurrent NEC and needed additional surgery, there were no anastomotic leakages and no strictures. All 12 infants survived and eight were still alive at median follow-up of 34.2 months. Of those who died, only one case was related to NEC. In comparison, of 14 infants who underwent intestinal resection and stoma formation, six were alive at median follow-up of 24 months and there were eight infants who developed NEC-related complications.
"The debate as to which surgical procedure is most appropriate in this challenging group of infants will undoubtedly continue. We have shown that outcome following intestinal resection and primary anastomosis when used in selected infants is comparable to that following stoma formation, and conclude that this technique is a valid surgical option even in infants weighing less than 1,000 g," the authors write.