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Outcome differences between gastroschisis repair methods
William F McNamara1, Charles W Hartin, Mauricio A Escobar
1Department of Surgery, State University of New York at Buffalo, New York 14642, USA. Yi-Horng_Lee@urmc.rochester.edu
Insights
Primary repair of gastroschisis offers better outcomes, showing less postoperative acidosis and fluid imbalance. This congenital defect repair should be prioritized when feasible for improved infant recovery.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Gastroschisis is a congenital abdominal wall defect requiring surgical repair.
- Repair methods include primary closure and staged closure, potentially impacting infant outcomes.
- Postoperative acidosis and fluid balance are key indicators of physiological stress post-repair.
Purpose of the Study:
- To compare the outcomes of primary versus staged closure for gastroschisis.
- To evaluate postoperative acidosis and fluid balance as markers of surgical stress.
- To identify factors influencing the choice of closure technique.
Main Methods:
- Retrospective review of 32 newborns with gastroschisis (2002-2008).
- Analysis of demographic data, gestational age, birth weight, and operative details.
- Statistical comparison using Fisher's exact test and unpaired t-test.
Main Results:
- Primary closure group had higher gestational age and birth weight.
- Significantly less postoperative metabolic acidosis and positive fluid balance in primary closure.
- Staged closures were more common in gastroschisis with intestinal atresia.
Conclusions:
- Primary repair of gastroschisis demonstrates physiological advantages.
- Reduced postoperative acidosis and fluid imbalance suggest better outcomes with primary closure.
- Further research is needed to clarify indications for each closure technique, but primary repair is recommended when possible.
Background:
Gastroschisis is a congenital abdominal wall defect that is repaired with either a primary closure or staged closure. The outcome of these infants may differ because of different closure techniques. In addition to the usual markers of parenteral nutrition (PN) use and length of stay (LOS) as outcome measures, we examined the duration of postoperative acidosis and positive fluid balance as markers for postoperative stress associated with these two techniques.
Methods:
A retrospective review of newborns with gastroschisis was conducted at a free-standing children's hospital from 2002 to 2008. The demographic data, gestational age, birth weight, operative reports, days on PN, LOS, duration of postoperative acidosis and fluid balances were reviewed. Data were analyzed using the Fisher's exact test or unpaired t test.
Results:
Thirty-two infants with gastroschisis were identified. One was excluded from analysis due to incomplete follow-up. The patients were classified as either primary closure (n = 8) or staged repair (n = 23). There was one death in our series. Patients who underwent primary closure had significantly older gestational age and higher birth weight. Primary closure is associated with significantly less duration of postoperative metabolic acidosis and fewer days with positive fluid balance. Patients who had primary repair also had less parenteral nutrition use and shorter length of hospitalization, though not statistically significant. Gastroschisis with associated intestinal atresia was more likely to be repaired with staged closures.
Conclusions:
There are physiologic advantages to primary repair of gastroschisis that can lead to better outcome, but the indications for the choices of closure technique remain unclear. Primary closure should be used when possible.