{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:05:07Z","timestamp":1792019107459,"version":"4.4.0"},"reference-count":209,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Surgical necrotising enterocolitis (NEC) continues to carry significant morbidity and mortality in preterm and very-low-birth-weight infants. This review presents up-to-date evidence to guide the shift from medical to surgical treatment and to improve management during and after surgery. Need for surgery is best anticipated through dynamic clinical assessment, supported by laboratory markers of systemic inflammation or ischemia and targeted imaging, while pneumoperitoneum remains the sole absolute indication for immediate intervention. In infants without perforation, the timing of surgery remains challenging: delayed surgery after clinical deterioration worsens long-term outcomes, whereas very early surgery often reflects severe disease leading to greater bowel loss, highlighting the need for carefully timed intervention after brief stabilisation. Laparotomy remains the cornerstone of surgical management, with peritoneal drainage serving as a temporising option for the most unstable infants and laparoscopy emerging as a feasible adjunct. Long-term complications, including strictures, short bowel syndrome, neurodevelopmental impairment, bronchopulmonary dysplasia and severe retinopathy of prematurity highlight the need for better predictive tools, enhanced imaging of bowel viability, and rigorous nutritional support, while long-term quality-of-life outcomes remain insufficiently studied.<\/jats:p>","DOI":"10.3390\/jcm15062236","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T08:41:26Z","timestamp":1773650486000},"page":"2236","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Surgical Necrotising Enterocolitis (S-NEC): Where We Stand Today: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9411-8852","authenticated-orcid":false,"given":"Maria","family":"Manousi","sequence":"first","affiliation":[{"name":"First Department of Pediatric Surgery, \u201cPan. & Aglaia Kyriakou\u201d Children\u2019s Hospital, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3419-4862","authenticated-orcid":false,"given":"Dionysios","family":"Dellaportas","sequence":"additional","affiliation":[{"name":"Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Nastos","sequence":"additional","affiliation":[{"name":"Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Siouli","sequence":"additional","affiliation":[{"name":"First Department of Pediatric Surgery, \u201cAghia Sophia\u201d Children\u2019s Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0100-2257","authenticated-orcid":false,"given":"Yvelise","family":"De Verney","sequence":"additional","affiliation":[{"name":"First Department of Pediatric Surgery, \u201cIASO\u201d Maternity and Children\u2019s Hospital, 15123 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5021-5152","authenticated-orcid":false,"given":"Anastasia","family":"Dimopoulou","sequence":"additional","affiliation":[{"name":"First Department of Pediatric Surgery, \u201cAghia Sophia\u201d Children\u2019s Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2546-4533","authenticated-orcid":false,"given":"Nikolaos","family":"Zavras","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s00383-023-05619-3","article-title":"Necrotizing enterocolitis: Current understanding of the prevention and management","volume":"40","author":"Hu","year":"2024","journal-title":"Pediatr. 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