Our Summary

This study is about finding the best surgical treatment for newborn babies with a severe intestinal condition called necrotizing enterocolitis (NEC). The researchers compared two types of surgery: creating a stoma (an artificial opening in the body for waste removal) or connecting the healthy parts of the intestine directly (anastomosis).

The research was carried out in 12 hospitals around the world and involved 80 infants who needed surgery for NEC. Each baby was randomly assigned to either the stoma or the anastomosis surgery.

The researchers found that babies who had the anastomosis surgery were able to stop relying on nutrition given through a vein (parenteral nutrition) more quickly than those who had a stoma. This suggests that they recovered faster from the disease.

There was no difference in the number of deaths between the two groups, and the rate of complications requiring additional unplanned surgeries was also similar. However, the group of babies who had a stoma experienced more multiple intestinal complications compared to the group who had anastomosis.

Based on these findings, the researchers recommend that, when the disease hasn’t spread to the parts of the intestine left after surgery, connecting the healthy parts directly (anastomosis) should be the chosen treatment. It helps the babies recover faster, reduces the risk of further intestinal complications, and doesn’t increase the risk of other negative outcomes.

FAQs

  1. What is the purpose of the STAT trial?
  2. What were the results of the STAT trial regarding the effectiveness of stoma formation versus primary anastomosis for neonates with necrotizing enterocolitis?
  3. Did the STAT trial find any difference in mortality or complication rates between stoma formation and primary anastomosis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to follow their post-operative care instructions closely, including taking prescribed medications, eating a balanced diet, staying hydrated, and gradually increasing physical activity as advised by their healthcare provider. It is also important to attend all follow-up appointments to monitor healing and address any concerns promptly.

Suitable For

Patients who are typically recommended bowel resection include those with necrotizing enterocolitis (NEC) requiring intestinal resection, where there is no disease distal to the resected intestine. In the context of NEC, a primary laparotomy may be performed for infants, and the choice between stoma formation and primary anastomosis is important. The study mentioned in the abstract suggests that primary anastomosis may be more effective in enhancing recovery from NEC, reducing the risk of multiple intestinal complications, and not increasing adverse outcomes compared to stoma formation.

Timeline

Before bowel resection:

  • Patient presents with symptoms of necrotizing enterocolitis (NEC) such as abdominal distension, feeding intolerance, and bloody stools.
  • Diagnostic tests such as imaging studies and blood tests are performed to confirm the diagnosis of NEC.
  • Patient may be started on antibiotics and given supportive care while awaiting surgery.
  • Intraoperatively, the operating surgeon determines whether a stoma formation or primary anastomosis is the most appropriate treatment option for the patient.

After bowel resection:

  • Patient undergoes either stoma formation or primary anastomosis during the surgical procedure.
  • Patients who undergo primary anastomosis have a shorter duration of parenteral nutrition compared to those who undergo stoma formation.
  • There is no significant difference in mortality between the two groups.
  • Patients who undergo stoma formation are more likely to experience multiple intestinal complications compared to those who undergo primary anastomosis.
  • Patients are monitored closely postoperatively for any complications and may require further unplanned operations if necessary.

What to Ask Your Doctor

  1. What is the reason for recommending a bowel resection procedure?
  2. What are the potential risks and complications associated with bowel resection surgery?
  3. How long is the recovery period expected to be after bowel resection surgery?
  4. Will I need to make any changes to my diet or lifestyle following the procedure?
  5. What is the success rate of bowel resection surgery in treating my condition?
  6. Are there any alternative treatment options to bowel resection that I should consider?
  7. How will bowel resection surgery affect my long-term health and quality of life?
  8. What follow-up care or monitoring will be needed after the procedure?
  9. How experienced is the surgical team in performing bowel resection surgeries?
  10. Are there any specific factors about my health or condition that may affect the outcome of the surgery?

Reference

Authors: Eaton S, Ganji N, Thyoka M, Shahroor M, Zani A, Pleasants-Terashita H, Ghazzaoui AE, Sivaraj J, Loukogeorgakis S, De Coppi P, Montedonico S, Sindjic-Antunovic S, Lukac M, Hamill J, Choo CSC, Nah SA, Hulscher J, Emil S, Petersen A, Wijnen R, Sloots C, Sigalet D, Kiely E, Svensson JF, Wester T, Pierro A. Journal: Pediatr Surg Int. 2024 Oct 29;40(1):279. doi: 10.1007/s00383-024-05853-3. PMID: 39470842