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Gastroschisis: primary closure using umbilical cord strengthened by a polypropylene mesh
Norberto Hernández Siverio1, Eudaldo M López-Tomassetti Fernández, Juan Mario Troyano Luque
1Department of Paediatric Surgery, Hospital Universitario de Canarias, Spain.
Insights
This study introduces a novel surgical repair for gastroschisis using an umbilical cord graft and polypropylene mesh. This method effectively closes abdominal wall defects, preventing future hernias in pediatric patients.
Area of Science:
- Pediatric Surgery
- Abdominal Wall Reconstruction
- Neonatal Care
Background:
- Gastroschisis presents a challenge due to abdominal cavity hypoplasia and eviscerated intestines.
- Primary abdominal wall closure can lead to dangerous increases in intra-abdominal pressure.
Observation:
- A novel technique utilizes an umbilical cord graft reinforced with a polypropylene mesh.
- This approach facilitates definitive abdominal wall closure in a single operative procedure.
Findings:
- The method creates a mesothelial surface adjacent to the intestines, promoting tissue integration.
- Postoperative fibrous encapsulation prevents subsequent herniation.
- A five-year follow-up of four patients demonstrated no instances of umbilical hernia and excellent overall outcomes.
Implications:
- This technique offers a viable solution for complex abdominal wall defects where primary closure is not feasible.
- It effectively prevents long-term complications such as future herniation.
- The procedure is easily applicable in pediatric surgical settings.
Aims:
We present a new method of repairing gastroschisis, where the disproportion between the size of the eviscerated intestine and the hypoplastic abdominal cavity could dangerously elevate abdominal pressure if primary closure of the abdominal wall is attempted.
Methods:
We used umbilical cord graft strengthened by a polypropylene mesh to achieve definitive closure of the abdominal wall in a single operation.
Results:
This technique provides a mesothelial surface in contact with the intestines, strengthened by a fibrous reaction that prevents future herniation. Five-year follow-up in four patients showed no umbilical hernias and overall excellent results.
Conclusions:
The technique described is useful and easily applicable in children with abdominal wall defects when primary anatomic closure is not feasible. It also prevents future herniation through the anatomical defect of the abdominal wall.
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