Necrotizing enterocolitis: escalation of surgical decisions

Abstract

Purpose of the study was to study the results of treatment of necrotizing enterocolitis in premature infants and to develop measures to improve surgical tactics. Materials and methods . A comparative analysis of the results of the treatment of necrotizing enterocolitis in 2 cohorts of premature infants (total 102 patients) differing in surgical tactics was performed in the Surgut Clinical Perinatal Center for the period from November 1, 2008 to December 31, 2018. Results . The choice of active surgical tactics when advancing intestinal perforation made it possible to carry out the most rational surgical intervention aimed at stopping the main pathological process and creating favorable conditions for further nursing of immature infants. The use of diagnostic laparoscopy facilitates the differential diagnosis and verification of indications for laparotomy. As a result of changes in surgical tactics, a mortality reduction of more than 2 times was achieved; according to the results of observation in the history office – the number of patients suffering from short bowel syndrome decreased by more than 4 times. Conclusions. High mortality in necrotizing enterocolitis among premature infants is due to the severity of abdominal sepsis and loss of intestinal length. Many diagnostic and therapeutic issues of supervision of this disease are pending. Laparotomy after the development of intestinal perforation is a tactically «late» intervention and makes it impossible to choose an adequate surgical strategy. Reasonable surgical intervention prior to intestinal perforation creates better conditions for the implementation of a favorable surgical solution. Improving surgical tactics increases the prospects for survival and nursing. In doubtful clinical cases, laparoscopy is effective in premature babies with suspected abdominal catastrophe. In the future, randomized trials should be conducted so that a primary anastomosis with proximal Santulli ileostomy can be recommended as an alternative to double terminal ileostomy in necrotizing enterocolitis.