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About SickKids

May 24, 2006

Multi-centre clinical trial finds two vastly different surgical procedures produce same results in infants with intestinal disorder

TORONTO – A minimally-invasive technique pioneered at The Hospital for Sick Children (SickKids) has proven to be as effective as surgery for treating premature infants with a severe intestinal disease, necrotizing enterocolitis, according to a study published in the May 25 issue of The New England Journal of Medicine.

The technique, called peritoneal drainage, involves placing a small drain under local anesthesia at the infant’s bedside, providing an alternative to undergoing a large procedure in the operating room. The peritoneal drainage technique was developed at SickKids in the early 1970s and has since been the preferred method of treatment at SickKids for premature infants weighing less than two pounds who have necrotizing enterocolitis.

“Rather than going to the operating room and performing what can be a big operation in a high risk, tiny, premature baby, we are able to treat the infant at the bedside with minimal disruption,” said Dr. Jacob Langer, chief of General Surgery at SickKids and professor at the University of Toronto. “Results from the clinical trial show that the technique first developed at SickKids and now used all over the world, is as effective as a large operation, with equally successful outcomes for the patient.”

Necrotizing enterocolitis (NEC) is a severe inflammatory disease of the intestine afflicting one infant out of every 2000 births and five to 10 per cent of premature infants weighing less than two pounds in Canada each year. In its most severe form, NEC results in perforation of part of the intestine, a condition with a high mortality rate.

For more than 25 years surgeons have used two radically different operations for these babies. The first and more aggressive, laparotomy and bowel resection, involves a large abdominal incision with removal of all of the affected intestine and creation of a stoma, which means bringing the end of the intestine through the abdomen to drain into a bag. The alternative option, peritoneal drainage, involves making a quarter of an inch incision in the lower abdomen and placing a small drain allowing egress of stool and pus from the abdomen without removing any intestine.

The multi-centre clinical trial led by Yale School of Medicine included 117 premature infants at 15 paediatric academic medical centers from the United States, as well as SickKids. When a baby developed perforated NEC at a study site, parents were counseled by the operating surgeons and offered enrollment into the trial. If they agreed, the operation their child received was assigned randomly.

“The study found that patient survival and other major outcomes for the two drastically different operations were virtually identical,” said lead author Dr. Larry Moss, chief of pediatric surgery in the Department of Surgery at Yale School of Medicine. “After 30 years of debate over which procedure is best, the first true scientific experiment addressing this question suggests that the method of the surgery may not be the important aspect of treatment.”

The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, is Canada’s most research-intensive hospital and the largest centre dedicated to improving children’s health in the country. As innovators in child health, SickKids improves the health of children by integrating care, research and teaching. Our mission is to provide the best in complex and specialized care by creating scientific and clinical advancements, sharing our knowledge and expertise and championing the development of an accessible, comprehensive and sustainable child health system. For more information, please visit www.sickkids.ca. SickKids is committed to healthier children for a better world.

For more information, please contact:

Media Contact
Public Affairs
The Hospital for Sick Children
Phone: 416-813-6380
Fax: 416-813-5328