Is there a role for high jejunostomy in the management of severe necrotising enterocolitis?

Necrotising enterocolitis (NEC) remains a common and severe condition affec ting both preterm and term infants. Treatment when NEC involves a large pro portion of the gastrointestinal tract remains controversial. We present one surgeon's experience of high jejunostomy (HJ) as the primary procedure in this group of children. HJ was performed in the presence of severe panintes tinal disease. In those who survived, a second-look procedure and reconstru ction was performed after 6 to 8 weeks. Over a 16-year period, 10 of 113 pa tients with NEC had a HJ constructed. Two died within 1 day due to persisti ng instability; the others survived to undergo a second-look laparotomy. In testinal continuity was restored in all cases with one to five anastomoses. Three patient's died within 1 year from total parenteral nutrition (TPN) r elated cholestasis and cirrhosis. Five became long-term TPN-free survivors. The HJ as an initial procedure is a useful surgical option in neonates wit h severe NEC affecting the majority of the intestine. In this high-risk gro up, we achieved 50% survival from NEC.