Between January 1975 and October 1987, 50 cases of necrotising enterocolitis (NEC) have required surgery. The principle that the best management is resection and exteriorisation of the ends, which was developed in the early 1970s, has been superseded by the realisation that resection and primary anastomosis can be safe in a well-resuscitated infant in whom the bowel ends appear viable. Eight babies had widespread NEC and no procedure was performed. Thirteen babies had resection and exteriorisation with five long-term survivors (39%). Twenty-nine babies had a primary anastomosis irrespective of birth weight, gestational age, length of resection, or the presence of peritonitis--with 22 (76%) long-term survivors. The pre-operative risk factors and length of bowel resected were similar in the two groups. The length of hospital stay, the period of total parenteral nutrition, the time to full feeds, and the time on a ventilator were all shorter in the primary anastomosis group, with no increase in short- or long-term morbidity or mortality. Provided that the bowel ends are viable, primary anastomosis is the procedure of choice for babies with NEC requiring laparotomy.