Outcomes of primary intestinal anastomosis versus stoma in necrotizing enterocolitis: A systematic review and meta-analysis.

Abstract

Approximately one-quarter of necrotizing enterocolitis (NEC) cases require surgical resection due to bowel perforation, necrosis, or failure to respond to conservative management. In such cases, the optimal method for restoring intestinal continuity remains debatable. Stoma is traditionally favored over primary anastomosis for its perceived safety, particularly in unstable infants, but it is associated with complications such as fluid and electrolyte imbalances, impaired growth, and the need for a second surgery. This study aims to systematically review and analyze the evidence comparing stoma versus primary anastomosis in neonates undergoing surgery for NEC. We searched PubMed, Web of Science (WOS), the Cochrane Library, and Scopus for studies comparing the outcomes of stoma versus primary anastomosis in neonates with NEC. The primary outcomes included overall postoperative complications, intestinal perforation, stricture, mortality, wound infection, time to full enteral nutrition, time to end parenteral nutrition, and length of hospital stay. The meta-analysis was conducted using Review Manager (RevMan) version 5.4. Eighteen studies were included in the meta-analysis. Primary anastomosis was associated with lower mortality risk: (risk ratios (RR) = 0.61; 95 % confidence interval (CI): 0.42:0.88). No significant differences were observed between groups in overall complications, wound infection, duration of hospital stay, duration of parenteral nutrition, the need for a second operation (excluding stoma closure), strictures, and perforations. Primary anastomosis for neonates with NEC is associated with lower mortality and comparable complication rates compared to stoma formation in selected cases.