AVOIDANCE OF STOMAS AND DELAYED ANASTOMOSIS FOR BOWEL NECROSIS - THE CLIP AND DROP-BACK TECHNIQUE

Necrotizing enterocolitis (NEC) and midgut volvulus (MGV) often are as sociated with extensive bower necrosis. These cases may require extens ive enterectomy and the formation of high or multiple stomas, and freq uently are complicated by short bowel syndrome, excessive fluid losses , fistulas, stenosis, and skin breakdown. This report describes a ''cl ip and drop-back'' technique, followed by delayed anastomosis performe d 48 to 72 hours later. The technique was successful in five severely ill infants (3 NEC, 2 MGV) with extensive necrosis, bowel perforation( s), and peritonitis, who required either a high stoma near the ligamen t of Treitz or multiple resections and enterostomies. This method remo ves obvious necrotic perforated bowel, controls contamination, avoids stomas (and their inherent complications in this age group), and prese rves bowel length. All five babies survived. The technique is a useful addition to the pediatric surgeon's operative armamentarium in select ive cases. (C) 1996 by W.B. Saunders Company