Primary fascial closure in 112 infants with gastroschisis
1Department of Surgery, Ratchaburi Hospital, Ratchaburi, Thailand.
Insights
Primary fascial closure for gastroschisis is recommended. This method, when feasible, leads to shorter hospital stays and reduced mortality compared to staged closure with prosthetic silos.
Area of Science:
- Pediatric Surgery
- Neonatal Surgery
Background:
- Gastroschisis, an abdominal wall defect, presents surgical challenges.
- Primary fascial closure versus staged closure using prosthetic silos is a debated approach.
Purpose of the Study:
- To evaluate the outcomes of primary fascial closure compared to staged prosthetic pouch closure for gastroschisis.
Main Methods:
- Retrospective review of 129 gastroschisis cases treated between August 1987 and August 2004.
- Analysis of patient demographics, associated anomalies, surgical techniques (primary closure vs. staged closure), and clinical outcomes.
Main Results:
- 112 patients underwent primary fascial closure; 17 required staged closure.
- Primary fascial closure was associated with shorter postoperative ileus and hospital stay.
- Mortality rates were lower with primary fascial closure (13.4%) compared to staged closure (35.3%).
Conclusions:
- Primary fascial closure should be the preferred treatment for gastroschisis when surgically possible.
- Technique success relies on abdominal cavity expansion and bowel volume reduction.
- Preoperative rectal irrigation is crucial for meconium evacuation.
Abstract:
Primary fascial closure of gastroschisis remains controversial. Some surgeons routinely place a prosthetic silo over the exposed bowel, planning a staged closure. From August 1987 to August 2004, 129 cases of gastroschisis were treated at the Pediatric Surgical Unit, Department of Surgery, Ratchaburi Hospital. There were 61 boys and 68 girls. One hundred and seven mothers were primigravida. Associated anomalies were present in 13 patients. One hundred and twelve patients underwent primary fascial closure. The success of this technique depends on enlarging the abdominal cavity and decreasing the volume of the bowel that must be replaced in the peritoneal cavity. Thorough preoperative rectal irrigation should evacuate all meconium. Seventeen patients required staged prosthetic pouch with final closure. The duration of postoperative ileus and length of hospital stay were shorter in infants who underwent primary fascial closure. Death occurred in 15 patients with primary fascial closure (13.4%) and 6 patients with staged prosthetic closure (35.3%). The present study indicated that primary fascial closure should be the treatment of choice whenever possible.
