The authors retrospectively review 331 cases of necrotizing enterocolitis from 13 different departments of pediatric surgery; 184 cases were treated only medically at the acute stage (47 of whom developed intestinal stricture) and 147 cases were operated on at the acute stage. The different procedures of acute surgical intervention are reported and the results of two surgical procedures are compared. The first is a classical one comprising a laparotomy with exploration of the intestinal tract and resection of the necrotic segments followed by enterostomy above the resected area. The other procedure comprises a minimal laparotomy in the right lower quadrant with ileostomy above necrotic areas, without resection of necrotic segments associated with peritoneal drainage. The results are assessed using the postoperative mortality rate and the number of secondary intestinal strictures. Mortality during the first postoperative month occurred in 27.9% of cases, and intestinal strictures were noted in 31.3% of cases after acute surgical procedure.