Introduction: Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in premature infants with 20-40% of all cases require surgical intervention.
Aim of study: To investigate the safety and effectiveness of primary anastomosis (PA) in patients with complicated NEC and the short and long-term outcomes, including the neurodevelopmental outcomes.
Methods: A two-part study includes a retrospective analysis of medical records of all infants who were diagnosed with NEC in the years 2000-2016 in the Galilee Medical Center and a prospective analysis regarding the late surgical and neurodevelopmental outcomes using parental questionnaires.
Results: Ninety-eight infants diagnosed with NEC were identified, 40 of whom were surgically treated. 22 underwent PA, 9 enterostomy (Ent) and 9 peritoneal drainage. The length of parenteral nutrition, antibiotic and hospitalization was shorter in PA. The number of infants who needed more than one surgical intervention due to complications was three times higher in Ent. There was no statistically difference between the PA and Ent infants for mortality rate. Normal developmental at 1-2 years after release was seeing in 40% of PA and 28% of Ent. Sever neurodevelopmental impairment was more common in Ent (70%) as oppose to PA (20%). 70% of PA infants were integrated into a regular education framework compare to 28% of Ent.
Conclusion: Primary anastomosis is a safe and effective surgical technique in the management of complicated NEC, with the same mortality rate compare to enterostomy, however, with a lower association to morbidity in the short term and better neurodevelopmental long-term outcomes.
