WOFAPS 2025 8th World Congress of Pediatric Surgery

Abdullah Bin Hidarah, Marion Arnold, Akhona Mbonisweni

Division of Pediatric surgery, University of Cape Town (UCT); Red Cross War Memorial Children’s hospital

Background:
Damage control laparotomy—also known as “clip-and-drop” (C&D) surgery—may improve survival in neonates with necrotizing enterocolitis (NEC) by allowing physiological stabilization prior to definitive surgery. However, outcomes are not well documented.

Aim:
To compare mortality and morbidity following C&D versus primary surgery (PS) in neonates with NEC.

Methods:
A retrospective review was conducted of neonates who underwent laparotomy with bowel resection for NEC at a tertiary pediatric surgery center between 1 January 2015 and 31 December 2022. Inclusion: laparotomy for NEC. Exclusion: incomplete records, gestational age >44 weeks, no bowel resection, or pan-intestinal necrosis. Patients were grouped by initial approach (C&D vs PS). Descriptive statistics (Excel 2010) and comparative tests (SPSS v30, IBM 2024: Mann-Whitney U, Chi-square, odds ratio) were used. Statistical significance was set at p<0.05.

Results:
Of 144 patients, 102 met inclusion criteria (C&D: 35; PS: 67); 42 were excluded. Patients in the C&D group had significantly higher baseline serum lactate (mean 4.6 vs 2.5 mmol/L; p=0.009), indicating worse preoperative status. Type of definitive surgery in survivors was similar: stoma formation [C&D: 21/35 (77%) vs PS: 44/67 (65%)] and primary anastomosis [C&D: 6/35 (22%) vs PS: 23/66 (34%); p=0.3]. Mortality was higher in the C&D group: 30-day [10/35 (28%) vs 10/67 (14%); p=0.1] and 6-month [17/35 (48%) vs 15/67 (22%); p=0.001].

Conclusion:
Despite higher early mortality likely due to poorer physiological status, C&D survivors had comparable surgical outcomes to PS. C&D may be a useful option in unstable NEC patients. Further multicenter studies are warranted.