Transluminal stenting: An intraoperative adjunct for preserving bowel length in the surgical management of necrotizing enterocolitis

Abstract

Surgical management of necrotizing enterocolitis (NEC) presents a morbid dilemma: it requires maximal preservation of the small bowel length to prevent complications such as short bowel syndrome while ensuring the resection of all necrotic and non-viable bowel segments. We performed a retrospective review of four single institution cases that underwent multiple small bowel resections and anastomoses for NEC. Transluminal stenting was used prior to restoring continuity to preserve small bowel length. All four infants had >40% of predicted bowel length after their procedure, and none of the infants in the first three cases required repeat surgery after the stent removal and returned and restored small bowel continuity. The stent in the fourth case is the most recent and will remain in place for six weeks. The mean time to stent removal was 58 days for the first three cases. All four infants are alive with only mild developmental delays and are tolerating oral feeds without any parental nutrition dependency. Our experience shows that transluminal stenting is an adequate bowel lengthening procedure to lessen the risk of short bowel syndrome without increasing mortality.