The Experience of Surgical Treatment of Necrotizing Enterocolitis

ABSTRACT

PURPOSE: Necrotizing enterocolitis (NEC) is a severe inflammatory disorder of the intestine, causing high mortality and morbidity. We investigated the single center experience about the operative indication, treatment method, and mortality in NEC. METHODS: The medical records of infants (<1 year old) who underwent the operation due to complications of NEC at the Asan Medical Center from Jan 1997 to Dec 2007 were retrospectively reviewed. RESULTS: Among 49 patients (MF = 3415), 37 underwent the operation at acute phase of NEC, average 26.43+/-35.43 days after birth (3~168), due to pneumoperitoneum in 23, clinical deterioration in 12 and abdominal mass in 2. Average gestational age was 234.64+/-38.27 days (161~279) and birth weight was 2,061.38+/-999.49 g (563~3,740). The extent of necrosis was classified grossly as focal in 14 cases, multifocal in 14 and panintestinal in 9 and the operative methods were enterostomy in 30 patients, resection and anastomosis in 6 and open drainage in 1. Thirteen patients (35.1%) were expired - 8 (21.6%) died of necrotizing enterocolitis and 5 died of other causes. The other 12 patients underwent operation for stricture after NEC at average 81.17+/-77.22 days after birth (32~317). Average gestational age was 240.83+/-34.4 days (173~280) and birth weight was 2,089.83+/-862.47 g (710~3,200). Eight patients underwent resection and anastomosis including stricture and 4 patients underwent enterostomy. CONCLUSION: Resection and enterostomy was the preferred procedure but resection and anastomosis did not increase morbidity or mortality. Quite a number of patients suffered from the stricture after NEC.