SURGICAL-TREATMENT OF NECROTIZING ENTEROCOLITIS - WHEN - HOW

In 10 years (1981-1990) 28 out of 54 neonates (51.8%) with definite ne crotizing enterocolitis (NEC) underwent surgery. Operation was perform ed at 13.5 +/- 8.8 (range 3-38) days of life, after 1.7 +/- 1.5 (range 1-6) days from the onset of symptoms. Aiming to perform laparotomy be fore the occurrence of perforation, surgery was liberally indicated in stage IIIa, according to Walsh-Kliegman. Explorative laparotomy (+per itoneal drainage in 2 cases) was performed in 4 patients with massive intestinal necrosis: all died within 3 days of surgery. In one neonate , only pneumatosis was present and resection was not considered mandat ory. Intestinal resection and enterostomy was performed in 17 neonates , 5 of them with perforation; three developed an intestinal stenosis. Enterostomy was closed after 116.2 +/- 61.8 days (range 26-193); 11 pa tients (64.7%) are long-term survivors. Intestinal resection and prima ry anastomosis was performed in 6 babies, 3 of them with perforation. Postoperatively, 2 dehiscences and 1 stenosis were recorded, but all c hildren survived. In our opinion, resection followed by primary anasto mosis seems to be the most satisfactory surgical option.