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Controversies in the management of gastroschisis: a study of 40 patients
M D Stringer1, R J Brereton, V M Wright
1Hospitals for Sick Children, London.
Insights
Prenatal transfer for gastroschisis (a birth defect) improved outcomes, with higher primary closure success and shorter ventilation needs. Primary repair is superior to staged repair for gastroschisis patients.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Gastroschisis is a congenital defect requiring surgical intervention.
- Management strategies for gastroschisis aim to optimize outcomes.
- Prenatal diagnosis and transfer may impact surgical management and results.
Purpose of the Study:
- To compare outcomes of gastroschisis repair based on transfer timing (prenatal vs. postnatal).
- To evaluate the effectiveness of primary closure versus staged repair for gastroschisis.
- To identify factors influencing survival and recovery in infants with gastroschisis.
Main Methods:
- Retrospective review of 40 infants with gastroschisis treated over 13 years.
- Comparison of outcomes between prenatally transferred and postnatally referred infants.
- Analysis of surgical repair methods: primary closure versus staged repair.
Main Results:
- Overall survival rate was 90%.
- Prenatally transferred infants had higher primary closure success (78% vs. 55%) and required less postoperative ventilation.
- Primary closure was associated with significantly better outcomes than staged repairs.
Conclusions:
- Prenatal transfer for gastroschisis may improve surgical outcomes and reduce the need for prolonged ventilation.
- Primary closure of the gastroschisis defect is preferable to staged repair.
- Further randomized studies are warranted to validate these findings.
Abstract:
Forty infants with gastroschisis were referred to two paediatric surgeons during a 13 year period. Overall survival was 90%. Nine patients were transferred in utero and 31 were referred postnatally. Birth weights, gestational ages, and Apgar scores were similar for both groups. Primary closure of the defect was successfully achieved in seven (78%) patients in the prenatally transferred group compared with 17 (55%) in the postnatal group. Significantly less postoperative assisted ventilation, and a trend in favour of early discharge home, were noted after prenatal transfer. Problems arising during postnatal transfer may have contributed to these differences. No major differences resulting from the mode of delivery were identified. Patients treated by primary closure fared significantly better than those undergoing staged repairs with prosthetic material. Prospective randomised studies are required to confirm these findings.