ABSTRACT
Some pediatric surgeons advocate resection of gangrenous intestine and primary anastomosis for infants with NEC, including some infants with intestinal perforation and peritonitis.51-54 In these series, results were generally good; however, in spite of careful selection and operation by expert pediatric surgeons, a few deaths in each series could be attributed to intraabdominal sepsis from an anastomotic leak. In the 1970s, the author’s experience with primary anastomosis55 and that of others56,57 showed an unacceptable rate of anastomotic leakage and stricture, leading to the recommendation that primary anastomosis should not be carried out. An analysis of 173 infants with advanced (surgical) NEC at the Children’s Hospital of Philadelphia found no advantage for primary anastomosis in selected patients with NEC, and concluded that it may actually jeopardize the survival of an infant who should be expected to live.58 O’Neill commented that a decision to perform primary anastomosis may lead to unnecessarily extensive resection, in order to assure that the bowel ends are unequivocally viable.59 Although the subject is debated,33,54 consensus still favors resection and enterostomy as the safer and preferred procedure for acute NEC.1,58,60,61
In infants who require resection of more than one segment, primary anastomosis ‘downstream’ from an enterostomy is safe from the risk of an anastomotic leak, although stricture may occur.
