EN
TÜRKÇE
Poster - 101
Timing and outcomes of surgical intervention in Necrotizing Enterocolitis : A 7-year retrospective study of 277 cases
Tahira Allahverdieva, Agil Abilov
Azerbaijan Medical University, Department of Pediatric Surgery, Baku
Aim of the study:
The study aimed to determine the optimal stage for surgical intervention in NEC ( Necrotising Enterocolitis ) management, focusing on mortality reduction.
Materials:
A retrospective analysis of 277 NEC patients (2016–2023) included birth details, treatment methods, surgical indications, and outcomes.
Results:
Of 7,584 births, 277 (3.7%) had NEC, with a male-to-female ratio of 1.5:1. Prematurity was observed in 79% of cases, and birth weights ranged from 490 to 3,900 g. Surgery was performed on 34 patients (12.2%), mostly on premature infants (82.3%).
Surgical indications included air in the portal vein (12), pneumatosis intestinalis (8), and pneumoperitoneum (2). Decision criteria encompassed poor clinical condition, thrombocytopenia, dilated bowel, palpable abdominal mass, and other factors (12) .
Procedures involved resection stoma (25), resection-anastomosis (3), multiple resection-anastomosis-stoma (3), and neovascularization through liver capsule incision (1). Ileocecal valve removal occurred in 10 total colonic NEC cases. A SECOND LOOK method (1), laparoscopy (5 cases), and intraperitoneal drainage (3 cases) were employed. No Hirschsprung's in 3 biopsies.
Some patients received proximal stomas for protective reasons. Stoma closure time averaged 86 days (14 days–6 months). Morbidity affected 25%, with one requiring surgical treatment for perforation proximal to the stoma. Mortality was 6%, while 25 patients developed sepsis postoperatively. Long-term complications included gallbladder stones (3 patients) and kidney stones (1 patient).
Conclusions:
Notably, multiple resection-anastomosis-stoma prevented anastomotic leakage. Suturing small intestines to the liver capsule induced neovascularization during total intestinal NEC. If intestinal perforation or intestinal necrosis is present in a patient with NEC, we recommend surgery if the operating room, anesthesia, and neonatology team are available. We believe that preservation of hypotension and hypothermia and the involvement of a neonatologist in the operation greatly increase the prognostic factor.