Outcomes of plastic closure in gastroschisis
Kristine Clodfelter Orion1, Michael Krein, Junlin Liao
1Department of Surgery, Division of Pediatric Surgery, University of Iowa, Iowa City, IA 52242, USA.
Insights
Plastic closure for gastroschisis (a congenital abdominal wall defect) reduces ventilator days and infection risk compared to traditional suture closure. This method is effective for both primary repair and after silo placement, improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Abnormalities
Background:
- Gastroschisis is a congenital defect where intestines exit the abdomen, risking obstruction and damage.
- Treatment involves covering abdominal contents, using primary closure or a temporary silo.
- Both traditional suture and sutureless plastic closures are used for gastroschisis repair.
Purpose of the Study:
- To evaluate the effectiveness of sutureless plastic closure for gastroschisis.
- To compare clinical outcomes between plastic closure and traditional suture closure.
Main Methods:
- Retrospective review of 80 patients (2000-2009) comparing plastic (52) and suture (28) closures.
- Analysis included patients requiring silos (31), with outcomes assessed via regression models.
- Key outcomes: ventilator days, enteral feeding initiation, hospital charges, duration of stay, mortality, and complications.
Main Results:
- Plastic closure associated with 4 fewer ventilator days (P < .01) and reduced infection/sepsis risk (OR, 5.15; P < .001) versus suture closure.
- In the silo cohort, plastic closure led to 7.5 fewer days to start enteral feeds (P < .01).
- No significant differences in time to goal feeds, parenteral nutrition, hospital charges, stay duration, or overall complications.
Conclusions:
- Sutureless plastic closure is effective for gastroschisis, both primarily and post-silo placement.
- Plastic closure demonstrates advantages in reducing mechanical ventilation duration and infection rates.
- Further research may explore long-term outcomes like ventral hernia rates, which showed no significant difference.
Background:
Gastroschisis is a congenital abdominal wall defect in which the intestines develop outside the abdomen and are exposed to amniotic fluid. When the defect is small, lymphatic, venous, and intestinal obstruction may occur and contribute to the formation of intestinal edema, atresia, ischemia, and a thick inflammatory peel. Treatment requires early coverage of abdominal contents either by primary closure or by the placement of temporary Silastic silo followed by abdominal wall closure. Currently, both traditional suture closure and the sutureless plastic closure are being employed to repair the gastroschisis defect. The goal of the current study is to evaluate plastic closure. We predict no difference will be found in clinical outcomes between plastic closure and traditional suture closure.
Methods:
A retrospective review of 80 patients treated between 2000 and 2009 was performed. Plastic closure was used in 52 (65%) and traditional suture closure in 28 (35%) babies. The surgical procedure was determined by surgeon preference. Of the 31(39%) babies who required silos, 15 (19%) were treated with plastic closure and 16 (20%) underwent traditional closure. We collected the following demographic data and clinical progression data. Using SAS 9.2 (SAS Institute Inc, Cary, NC), we conducted linear regression, logistic regression, and time to event models to compare the following outcomes: days on ventilator, days to start enteral feeds, days to reach goal enteral feeds, days on total parenteral nutrition, hospital charges, duration of stay, mortality, and complications.
Results:
The mean duration of follow-up was 11.4 months. Patients spent an average of 6 days on the ventilator. There were 2 mortalities. A multivariate analysis demonstrated that no differences were found between the 2 closures with most of the outcomes; however, when compared with traditional suture closure, those babies treated with plastic closure spent 4 days fewer days on the ventilator (P < .01). Those babies who underwent suture closure were more likely to have an infection or sepsis (odds ratio, 5.15; P < .001). When the entire cohort was considered, no significant difference was found between plastic and suture closure in time to start feeds, time to reach goal feeds, time on parenteral nutrition, hospital charges, duration of stay, or complications. Ventral hernias were noted in 46 (58%) patients, 32 (62%) after plastic closure and 14 (50%) after suture closure (P = .32). Hernia repair was required in 16 (20%) patients, 11 (21%) after plastic closure, and 5 (18%) after traditional repair (P = .32). In the silo cohort, children treated with plastic closure required 7.5(P < .01) fewer days to start enteral feeds than those treated with suture closure.
Conclusion:
Plastic closure of abdominal wall defects in gastroschisis is effective both as a primary procedure and after silo placement. A multivariate analysis shows plastic closure to be associated with fewer days of mechanical ventilation and less likelihood of developing infection or sepsis.
