Primary Anastomosis Versus Enterostomy in the Surgical Treatment of Necrotising Enterocolitis

  • End date
    Jan 31, 2025
  • participants needed
  • sponsor
    The University of Hong Kong
Updated on 8 October 2021


Necrotizing enterocolitis (NEC) is a devastating disease that affects the intestine of premature infants and is the most common surgical emergency in newborns. It is estimated that up to 10% of premature babies can suffer from this condition. Despite aggressive medical treatment, surgical intervention is necessary in up half of the cases for bowel necrosis or perforation and these often represent the more severe form of the disease. The advances in neonatal intensive care and surgical knowledge have resulted in improved survival rate in recent years.

For NEC patients with severe disease (i.e.) those with intestinal perforation or gangrenous bowel not responding to medical therapy, surgery with resection of diseased segments is the treatment of choice. Traditional surgical approach would be to resect the diseased bowel segment with formation of enterostomy. However, in a few advanced centres, primary anastomosis after the resection of diseased bowel segment is practised. Retrospective reports of the primary anastomosis approach have shown that this is also a viable option with no increased rate of peri-operative morbidity. It also has the advantage of avoiding a second operation for enterostomy closure. Nonetheless, prospective studies comparing the two approaches are lacking.

The proposed study will fill up the following knowledge gap on what the best surgical option for NEC at laparotomy is. The findings will help guide our practice for NEC patients in the future in order to provide them with the best possible and evidence-based care.

In this study, the investigators hypothesize that neonates with major NEC undergoing primary anastomosis after surgical resection is not inferior to neonates who have enterostomy, in terms of peri-operative morbidities.

Aim of the study is to compare the short term and medium term outcomes of NEC patients requiring surgical intervention who either receive primary anastomosis or enterostomy creation.

Condition Necrotizing enterocolitis
Treatment Primary anastomosis, Enterostomy, Enterostomy
Clinical Study IdentifierNCT04912453
SponsorThe University of Hong Kong
Last Modified on8 October 2021


Yes No Not Sure

Inclusion Criteria

All neonates with confirmed NEC and require surgical intervention will be included

Exclusion Criteria

Neonates found to have NEC totalis and deemed unsalvageable
Neonates found to have multiple sites of gangrenous bowels which require more than two anastomoses
Neonates found to be extremely unstable cardiovascularly intra-operatively and can only withstand excision of gangrenous bowels, but will not allow anastomosis or stoma creation
Parents who do not agree to participate in the study
Neonates found to have pathology other than NEC after recruitment (either on intraoperative findings or pathological findings on surgical specimens)
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