Surgical treatment of necrotizing enterocolitis: single-centre experience from Saudi Arabia

Abstract

Aim The aim of this study was to investigate our indications of laparotomy, surgical procedures and their results, and to compare our results with those of others. In necrotizing enterocolitis (NEC), indications of surgery, surgical strategy and results vary.
Materials and methods This study was conducted at the regional tertiary care referral centre. The study design was a retrospective one. Case records of 24  patients with advanced NEC who underwent laparotomy over a 7-year period were analysed. Demographic data, clinical features, laboratory and skiagram findings,  indication for surgery, operative findings, procedures performed, immediate surgery-related complications and postoperative survival were studied.
Results The mean age was 20.29 days (range = 3–82 days). The mean birth weight was 1810.5 g (range = 660–3000 g). Seventy-five percent of babies were premature. Indications of surgery were as follows: pneumoperitoneum (16), failure to improve with adequate medical treatment (three), abdominal tenderness and rigidity (two), abdominal wall oedema and erythema (two), and acute intestinal obstruction (one). Peritoneal drainage was carried out in five patients, of whom two (40%) survived after laparotomy. Thirteen (54.17%) patients had focal, nine (37.5%)  multifocal and two (8.33%) had panintestinal NEC. Six patients underwent resection anastomosis (RA) and 16 underwent enterostomy. Surgery-related complications occurred in six patients. The overall mortality was eight (33.33%). Two (33.33%) of the six RA patients, four (25%) of 16 stoma patients and two (100%) with  corporation panintestinal disease died.
Conclusion The most common indication for laparotomy in NEC was  pneumoperitoneum. We performed laparotomy in drain-managed patients when  stable; 40% of such patients survived. We preferred gangrene resection and enterostomy to RA. Mortality and morbidity in the RA group were higher than that in the stoma group; dead RA patients had multifocal disease. Survival rate of  laparotomy-NEC patients (66.66%) was comparable to that of other centres.

Keywords: enterostomy in necrotizing enterocolitis, laparotomy in necrotizing enterocolitis, resection and anastomosis in necrotizing enterocolitis, survival in surgical-necrotizing enterocolitis, surgical necrotising enterocolitis