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Gastroschisis: a 15-year, single-center experience
Amulya K Saxena1, Georg Hülskamp, Jürgen Schleef
1Pediatric Surgical Clinic, Westfälische Wilhelms University, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany. saxena@post.com
Insights
Solvent-dried dura (SDD) grafts are effective for repairing large gastroschisis (GS) defects in infants. This study found SDD implants to be a safe and acceptable biomaterial with minimal complications, supporting their use in complex GS cases.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Biomaterials Science
Background:
- Gastroschisis (GS) is a congenital abdominal wall defect requiring surgical intervention.
- Management of large GS defects presents challenges in achieving primary closure.
- Solvent-dried dura (SDD) is a potential biomaterial for abdominal wall reconstruction.
Purpose of the Study:
- To evaluate the efficacy and safety of solvent-dried dura (SDD) grafts for surgical repair of gastroschisis (GS).
- To assess complications and outcomes associated with SDD graft use in GS patients.
Main Methods:
- Retrospective analysis of 70 gastroschisis cases surgically treated between 1984 and 1998.
- Surgical repair techniques included primary closure, single SDD graft, and double SDD graft for fascial enlargement.
- Data collected on patient demographics, delivery methods, associated anomalies, surgical outcomes, and complications.
Main Results:
- 41 infants (58.6%) required two SDD grafts for closure of extensive defects.
- Associated anomalies were present in 31.4% of patients, most commonly bowel atresias.
- Overall mortality was 2.8%; no major complications were linked to SDD implants, with only 5.7% experiencing minor issues.
Conclusions:
- Solvent-dried dura (SDD) implants are an acceptable and safe biomaterial for repairing large gastroschisis defects.
- SDD grafts facilitate successful closure in complex cases, demonstrating a low rate of significant complications.
- The findings support the continued use of SDD grafts in the management of challenging gastroschisis cases.
Abstract:
70 cases of gastroschisis (GS) were surgically treated at the Pediatric Surgical University Clinic, Münster, from 1984 through 1998. The defect occurred more frequently in males (44) than females (26). The average birth weight was 2,383 g and mean gestational age 36.8 weeks. 9 infants (12.9%) were delivered vaginally and the rest (87.1%) by cesarean section; 34 of the 61 (55.7%) cesarean sections were done solely for prenatal ultrasonic identification of the abdominal-wall defect. 10 infants (14.3%) underwent primary closure; in 19 (27.1%) primary closure of the skin was possible, however, a single solvent-dried dura (SDD) graft was required for fascial enlargement. The remaining 41 infants (58.6%) had extensive defects and required two grafts for optimal closure. 22 patients (31.4%) had associated anomalies, the most common being bowel atresias and undescended testis. 14 (20%) required secondary laparotomies because of bowel-associated complications and 1 (1.4%) for a urinary-bladder perforation. 11 patients (15.7%) had non-bowel-associated complications. The average postoperative tracheal intubation time was 3.9 days and the average hospital stay was 75.6 days. The overall mortality was 2.8%. No major complications associated with SDD implants were encountered; only 4 patients (5.7%) had minor complications such as local inflamation and infection and were managed conservatively. The present data support the employment of SDD implants as acceptable biomaterial for the repair of large GS defects.
