Early postoperative outcomes of surgery for intestinal perforation in NEC based on intestinal location of disease

Current surgical strategies for necrotizing enterocolitis (NEC) include primary drainage, resection with enterostomies, and primary anastomosis. There is considerable controversy regarding the preferable surgical management of NEC. We sought to investigate whether the surgical outcomes of newborns with NEC undergoing exploratory laparotomy differed according to the location of the disease site. A total of 204 patients with NEC following laparotomy between July 2007 and May 2017 were retrospectively reviewed. Clinical outcomes, including mortality, neonatal intensive care unit (NICU) length of stay and complications, were evaluated based on the type of surgical operation. Enterostomy creation or primary anastomosis was performed in 98 patients, and 106 cases underwent laparotomy and simple drainage because of panintestinal involvement with near total intestinal compromise or no perforation. The ileum was the most commonly affected location (n = 170, 83.3%). Patients who had undergone a simple drainage procedure experienced less blood loss (P = .023) and a shorter procedure time (P = .061), although no statistical significance was attained. Infants with bowel anastomosis or ostomy had significantly shorter times to beginning enteral feeds (P = .023) and times on mechanical ventilation (P = .011) compared with infants who had undergone drainage (Student's t test). The mean NICU length of stay (P = .088) was longer for the patients with drainage, although the difference did not attain significant. No difference in the overall mortality rate was detected between the 2 groups (P = .10). The postoperative outcomes in newborns undergoing laparotomy were associated with the surgical type, which was determined by disease location in the bowel.