Laparotomy or peritoneal drain: Where does the evidence lead?

Necrotizing enterocolitis (NEC) is a leading cause of death among preterm neonates, leading to increased hospital care and economic burden. Based on all the available randomized control trials and observational studies to date, the peritoneal drain placement is most likely associated with higher mortality than laparotomy when the NEC diagnosis is made prior to the intervention. Peritoneal drainage, however, may be utilized as a bridge treatment in cases where early operation is not possible due to clinical instability or not immediately available. Unfortunately, most studies lack histopathological confirmation of radiographic abnormalities corresponding to NEC or spontaneous intestinal perforation (SIP). Such large prospective studies evaluating the impact of peritoneal drain and laparotomy, which utilize pre-determined histopathologic definitions of NEC/SIP, are necessary to optimize clinical outcomes.