摘要
Background: Strategies for the surgical management of necrotising enterocolit is are various and controversial. Objective: To characterise variation in surgic al management of this disease across the United Kingdom. Methods: Postal survey of 104 consultant paediatric surgeons with a 77% response rate. Results: Durat ion of antibiotic treatment (median 10 days, range 6- 14), time until the start of enteral feeding (median 10 days, range 4- 21), and absolute indications for surgery all vary between surgeons. Peritoneal drainage is used by 95% of surg eons. Forty two percent use it in neonates of all weights, whereas 36% restric t its use to those < 1000 g. Peritoneal drainage is used for stabilisation by 9 5% and as definitive treatment by 58% . At laparotomy, operative procedures i nclude diverting jejunostomy, resection and stoma, resection with primary anasto mosis, and “ clip and drop” . All procedures are used in infants of all weight s except resection and pri mary anastomosis, which is used predominantly in larger infants (55% in < 1 000 g; 77% in > 1000 g; p=0.005). Infants may be considered too unwell for peritoneal drainage by 11% of surgeons compared with 90% for laparotomy (p < 0.0001). Conclusions: There is considerable variation in surgical strategies f or necrotising enterocolitis. Peritoneal drainage is used by most surgeons, with controversial indications and expectations. The use of resection and primary an astomosis is influenced by the weight of the neonate.
Background: Strategies for the surgical management of necrotising enterocolit is are various and controversial. Objective: To characterise variation in surgic al management of this disease across the United Kingdom. Methods: Postal survey of 104 consultant paediatric surgeons with a 77% response rate. Results: Durat ion of antibiotic treatment (median 10 days, range 6- 14), time until the start of enteral feeding (median 10 days, range 4- 21), and absolute indications for surgery all vary between surgeons. Peritoneal drainage is used by 95% of surg eons. Forty two percent use it in neonates of all weights, whereas 36% restric t its use to those < 1000 g. Peritoneal drainage is used for stabilisation by 9 5% and as definitive treatment by 58% . At laparotomy, operative procedures i nclude diverting jejunostomy, resection and stoma, resection with primary anasto mosis, and “ clip and drop” . All procedures are used in infants of all weight s except resection and pri mary anastomosis, which is used predominantly in larger infants (55% in < 1 000 g; 77% in > 1000 g; p=0.005). Infants may be considered too unwell for peritoneal drainage by 11% of surgeons compared with 90% for laparotomy (p < 0.0001). Conclusions: There is considerable variation in surgical strategies f or necrotising enterocolitis. Peritoneal drainage is used by most surgeons, with controversial indications and expectations. The use of resection and primary an astomosis is influenced by the weight of the neonate.
