Necrotizing enterocolitis: Extent of disease and surgical treatment

Purpose: The aim of this study was to evaluate the results of surgical trea tment of necrotizing enterocolitis (NEC) according to the extent of disease and to establish if resection of the ileocecal valve represents a poor pro gnostic factor. Methods: The authors reviewed all cases of NEC (n = 161) treated in our hos pital during the last 11 years; of these, 83 required surgical intervention . Definitions used by the authors include isolated, disease in a single int estinal segment; multifocal, disease in two or more intestinal segments; an d pan-intestinal, majority of small and large bowel involved. Results: Twenty-five neonates had isolated NEC, 46 neonates had multifocal NEC, and 12 had pan-intestinal involvement. Survival rate was affected by t he extent of intestinal involvement, the lowest survival rate (33%) being n oticed in neonates with pan-intestinal involvement. In patients with isolat ed NEC, postoperative complications and survival rate were not affected by the modality of operative treatment. Conversely, in patients with multifoca l NEC, survival rate was higher (85%) after resection and primary anastomos is compared with enterostomy (50%; P = .03). Resection of the ileocecal val ve was not associated with increased morbidity and mortality. Conclusions: (1) Resection and primary anastomosis is a valid treatment opt ion in both isolated and multifocal NEC. (2) Neonates with NEC adapt rapidl y to the loss of the ileocecal valve. J Pediatr Surg 34:1096;1099. Copyrigh t (C) 1999 by W.B. Saunders Company.