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Reappraisal of skin flap closure for neonatal gastroschisis
Insights
This study shows that primary skin closure for gastroschisis (abdominal wall defects) in infants, combined with intravenous feeding and later hernia repair, results in high survival rates. This technique is effective for treating gastroschisis.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Gastroschisis is a congenital defect where the infant's intestines protrude through an opening in the abdominal wall.
- Surgical repair is necessary to close the abdominal wall defect and return organs to the abdominal cavity.
Purpose of the Study:
- To evaluate the outcomes of surgical repair for gastroschisis using primary skin closure.
- To assess the long-term viability and complications associated with this treatment approach.
Main Methods:
- Retrospective review of 18 infants with gastroschisis treated over 11 years.
- Surgical repair involved primary skin flap closure, gastrostomy, and peripheral intravenous hyperalimentation.
- Second-stage ventral hernia repair was performed as needed.
Main Results:
- A high survival rate of 89% (16 out of 18 infants) was observed beyond one year post-repair.
- Twelve infants required and underwent subsequent repair of ventral hernias.
- The described surgical technique facilitated abdominal wall closure and bowel management.
Conclusions:
- Primary skin closure for gastroschisis, supported by intravenous hyperalimentation and delayed ventral hernia repair, is a successful and justifiable technique.
- This approach demonstrates low morbidity and mortality rates.
- Prosthetic materials are best reserved for more complex abdominal wall reconstructions.
Abstract:
During the past 11 years, 18 infants with gastroschisis abdominal wall defects have undergone surgical repair at the UCLA Hospital. Sixteen infants had skin flap closure in infancy. A gastrostomy was performed on all infants, and peripheral intravenous hyperalimentation was used in 14 of the 18 infants. Sixteen of the 18 infants (89%) lived more than one year after surgical repair. Of these, 12 have undergone second-stage closure of the ventral hernia. Operative repair was greatly facilitated by forceful stretching of the abdominal musculature and milking of the bowel contents proximally into the stomach and distally out through the anus. The low morbidity and mortality of gastroschisis repair by primary skin closure, supplemented by intravensou hyperalimentation with late secondary ventral hernia repair, appear to justify continued use of this technique. Prosthetic materials probably should be reserved for reconstructing more complex abdominal wall defects.