Primary Anastomosis Versus Enterostomy in the Surgical Treatment of Necrotising Enterocolitis

Not Applicable

Recruiting

• Conditions: Necrotizing Enterocolitis
• Interventions: Procedure: Primary anastomosis; Procedure: Enterostomy

• Registration Number: NCT04912453
• Lead Sponsor: The University of Hong Kong

Brief Summary

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.

Detailed Description

Not available

Basic Information
|
Recruitment & Eligibility
|
Study & Design
|
Trial Locations

Study Timeline

• Study First Submitted: 2021-05-28
• Study First Submitted QC: 2021-05-28
• Study First Posted: 2021-06-03
• Study Start: 2021-07-01
• Status Verified: 2024-05
• Last Update Submitted: 2024-12-05
• Last Update Posted: 2024-12-11
• Primary Completion: 2025-06-30
• Study Completion: 2025-12-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 90

Inclusion Criteria

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

Read More

Exclusion Criteria

1. Neonates found to have NEC totalis and deemed unsalvageable;
2. Neonates found to have multiple sites of gangrenous bowels which require more than two anastomoses;
3. 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;
4. Parents who do not agree to participate in the study
5. Neonates found to have pathology other than NEC after recruitment (either on intraoperative findings or pathological findings on surgical specimens).

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Primary anastomosis group	Primary anastomosis	-
Enterostomy group	Enterostomy	-

Primary Outcome Measures

Name	Time	Method
Re-operation rate of the two surgical approaches	6 months

Secondary Outcome Measures

Name	Time	Method
Wound-related problems	6 months	Wound problems not requiring re-operations e.g. wound infection; stomal prolapse; incisional hernia
Time to full enteral feeding	6 months	Time needed (in term of days) to achieve full enteral feeding (defined as 150ml/kg/day) and stoppage of parenteral feeding

Trial Locations

Locations (1)

Department of Surgery, University of Hong Kong; 🇭🇰 Hong Kong, Hong Kong