WOFAPS 2025 8th World Congress of Pediatric Surgery

Purpose:

Necrotising enterocolitis (NEC) is a multifactorial condition predominantly seen in premature neonates, characterised by intestinal inflammation and systemic response leading to bowel necrosis and perforation. Mortality may be up to 30-50%.

We present our institutional experience where early surgical involvement is performed in these infants in the form of damage control surgery (DCS). DCS involves a limited initial procedure, focussing on managing the lethal triad of acidosis, hypothermia and coagulopathy rather than a definitive repair (1).

Method:

A retrospective review and follow-up of all neonates who underwent DCS for NEC at our institution between 2017- 2024.

Results:

Twenty-one neonates (12 male, 9 female) with a gestation age ranging 22+5 - 38 weeks and birth weight ranging 485 - 2350 grams were included. Indications for surgery included perforation (n=4) and failure of maximum medical management with abdominal discolouration, tenderness, mass, or fixed bowel loop on x-ray (n=17). One neonate died prior to surgery and care was withdrawn intra-operatively for another.

NEC was confirmed intra-operatively in all. Thirteen neonates had patchy bowel necrosis (4 cm - 68 cm). Planned re-laparotomies at 36–48 hours were performed in all; four required further resection. Primary anastomosis was achieved in all. The shortest residual bowel was 65cm (with patent ileocecal valve). The longest duration of parenteral nutrition was three months.

At 18 months follow-up, on average, all children were discharged from specialist care and doing well.

Conclusion:

Early surgical intervention in conjunction with DCS is a safe and effective management strategy for advanced NEC. It usually facilitates primary anastomosis, thus avoiding stomas with their associated complications. Our experience demonstrates excellent short and long-term outcomes.

References:

1. G Arul , M Singh , A Ali, O Gee. Damage control surgery in neonates: Lessons learned from the battlefield. Journal of Pediatric Surgery. 54 (2019) 2069–2074