Primary anastomosis in the management of newborns with necrotizing enterocolitis 
 

Pereiaslov A. A., Borys O. Ya., Shakhov K. V.

Lviv National Medical University named after Danylo Halytskyi, Ukraine

Ivano-Frankivsk National Medical University, Ukraine

Necrotizing enterocolitis (NEC) — one of the lifethreatening diseases of newborns associated with the high (20–40%) mortality. Decision about the method of completing surgical intervention after the removal of necrotic changed bowel — stoma formation or primary anastomosis — is still under discussion.

The objective of the study was to summarize own experience of using primary anastomosis in the management of newborns with NEC.

Material and methods. The study was based on the outcomes of surgical treatment of 62 newborns with the different degree of NEC severity. The diagnosis was established on the basis of objective examination and instrumental methods (X-ray, ultrasound and Doppler). In 41 (66.1%) newborns after intestine resection the stoma was made, and in 21 (33.9%) — the surgery was completed by the primary anastomosis.

Results and discussion. Total mortality among newborns after surgical treatment was 17.7% (11 newborns), in particular after stoma formation — 19.5% (8 newborns) and after primary anastomosis — 14.3% (3 babies). Various postoperative complications developed in 17 (41.5%) children after the stoma formation and in 5 (23.8%) patients after the primary anastomosis. The problem of the choice of method for surgery completion in children with NEC should be decided individually, taking into account the prevalence of necrotic changes in the bowel, hemodynamic status during surgery and surgeon experience. The use of intraoperative Doppler ultrasonography enables to clearly identify intestinal areas with absent or decreased blood flow, which gives the opportunity to perform bowel resection within healthy tissues.

Conclusions. Our researches confirmed that the primary anastomosis in the presence of clear indications is a safe and effective treatment in infants with NEC associated with lesser complications and lower mortality.

Key words: necrotizing enterocolitis, surgical treatment, primary anastomosis.

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