Primary Peritoneal Drainage Versus Laparotomy for Perforated Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants: A Retrospective Cohort Study at an Academic Center in Saudi Arabia

Background and objective Necrotizing enterocolitis (NEC) is a detrimental complication of the gastrointestinal tract among preterm infants with very low birth weight (VLBW) and is associated with high morbidity and mortality. About one-third of these cases require surgical intervention due to intestinal perforation. The preferred method for the surgical management of perforated NEC is still a matter of controversy. In light of this, we aimed to compare the outcomes of treating perforated NEC in VLBW infants with primary peritoneal drainage (PPD) versus laparotomy. Method We conducted a retrospective chart review of VLBW infants with perforated NEC treated at King Abdulaziz University Hospital between January 1, 2015, and March 31, 2020. Results Twenty-seven infants with perforated NEC were identified; 12 were managed initially with PPD, and 15 underwent laparotomy. There was no difference between groups in terms of postoperative outcomes, length of hospital stay, or mortality before discharge. Among infants managed with PPD, 50% (5/10) underwent second drainage and survived, while 33% (4/12) underwent laparotomy. Conclusion We identified no difference in postoperative outcomes and mortality between managing perforated NEC in VLBW infants with either PPD or laparotomy. However, randomized clinical trials with larger sample sizes and defined outcome measures are needed for reaching definitive conclusions.