Surgical Management of Necrotising Enterocolitis

Between 20% and 40% of infants with NEC will require surgical treatment. The absolute indication for surgery is radiological evidence of intestinal perforation. In the absence of this, it can be very challenging to identify clearly which infants need surgical intervention. Multiple other factors have been identified that suggest the need for surgery but currently there is no single factor that allows simple discrimination between those that will recover with medical therapy alone and those that need intervention. There is good evidence that, with appropriate experience, abdominal ultrasonography is effective but it remains operator dependent. There is undoubtedly a role for peritoneal drainage as a stabilising procedure for NEC with perforation, in infants who cannot tolerate a laparotomy and potentially as a definitive intervention. Some babies who have intestinal resection will need a stoma but in the majority of cases, primary anastomosis is a safe and effective option. There is also a role for laparostomy and a ‘second-look’ procedure in the surgical management of NEC.