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Advances in the Surgical Treatment of Gastroschisis
Arash Safavi1, Erik D Skarsgard2
1Department of Surgery, University of Arizona, Tucson, Arizona.
Insights
Gastroschisis (GS) is an abdominal wall defect affecting 4 in 10,000 pregnancies. This review analyzes surgical techniques for GS closure, including traditional sutured closure, silo placement, and innovative sutureless methods, to improve infant outcomes.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Congenital anomalies
Background:
- Gastroschisis (GS) is a congenital anterior abdominal wall defect impacting approximately 4 in 10,000 pregnancies.
- Infants with GS necessitate specialized neonatal intensive care and prompt surgical intervention.
- While survival rates exceed 90%, significant morbidity and prolonged, resource-intensive care are common.
Purpose of the Study:
- To review the historical evolution of surgical techniques for gastroschisis (GS) abdominal wall defect closure.
- To analyze current surgical approaches, including silo placement and sutureless closure.
- To compare the clinical effectiveness of different gastroschisis closure methods.
Main Methods:
- Review of historical surgical management strategies for gastroschisis.
- Analysis of contemporary techniques: primary closure, silo placement with delayed closure, and sutureless closure.
- Comparative evaluation of clinical outcomes and effectiveness across different closure methods.
Main Results:
- Traditional early sutured closure aims for rapid enteral feeding establishment.
- Delayed closure with silo placement offers a life-saving alternative when early reduction is not feasible.
- Sutureless closure presents a novel approach with potential benefits like avoiding general anesthesia.
Conclusions:
- The optimal surgical approach for gastroschisis closure remains a subject of ongoing debate.
- Silo placement and delayed closure have become increasingly utilized, especially with advancements in neonatal care.
- Innovative techniques like sutureless closure warrant further investigation for improved patient outcomes and resource utilization.
Abstract:
Gastroschisis (GS) is a structural defect of the anterior abdominal wall, usually diagnosed antenatally, that occurs with a frequency of approximately 4 per 10,000 pregnancies. Babies born with GS require neonatal intensive care and surgical management of the abdominal wall defect soon after birth. Although contemporary survival rates for GS are over 90%, these babies are at risk for significant morbidity, and require 4 to 6 weeks of costly, resource-intensive care in specialized neonatal units. Much consideration has been given to how best to treat the abdominal wall defect of GS. The traditional approach, necessitated by a need to establish enteral feeding as quickly as possible, consists of early postnatal visceral reduction and sutured abdominal closure. Advances in neonatal nutritional support have enabled the development of surgical approaches, which permit gradual visceral reduction and delayed abdominal closure. In cases where early visceral reduction cannot be achieved, delayed closure enabled by the initial placement of a prosthetic silo has been a live-saving alternative. The development of preformed silos has simplified their use and led to an interest in treating all cases with a delayed closure philosophy. Most recently, a sutureless technique of abdominal closure has been reported, which has the benefit of avoiding general anesthesia and offers other outcome improvements over sutured closure of the defect. The debate over primary closure versus silo placement and delayed closure continues to receive much attention. The goal of this article is to review historical aspects of gastroschisis closure, and then focus on current surgical techniques, including the innovative sutureless closure, with an analysis of the comparative clinical effectiveness of these approaches to treatment of the abdominal wall defect in GS.
