[Primary versus secondary closure: ventilatory and nutritional differences in patients with gastrosquisis]
M Dore Reyes1, P Triana Junco1, S Barrena Delfa1
1Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
Insights
Primary closure for gastroschisis offers shorter ventilator support and parenteral nutrition dependency compared to surgical silo techniques. Both methods demonstrate similar safety and effectiveness for infant outcomes.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Congenital anomalies
Background:
- Gastroschisis is a congenital defect requiring surgical intervention.
- Surgical management options include primary closure and staged closure with silos.
- Optimal treatment strategy for gastroschisis remains a subject of ongoing debate.
Purpose of the Study:
- To compare outcomes between primary closure (PC) and surgical silo (SS) techniques for gastroschisis.
- To identify differences in recovery, complications, and resource utilization.
Main Methods:
- Retrospective analysis of gastroschisis patients treated between 2004 and 2014.
- Patients categorized into PC and SS groups based on abdominal wall closure method.
- Statistical analysis using non-parametric methods; significance set at p < 0.05.
Main Results:
- No significant differences in sex, gestational age, or birth weight between PC and SS groups.
- PC group required significantly fewer ventilation days (4 vs 13) and less parenteral nutrition (PN) dependency (12 vs 20 days).
- Similar rates of post-operative complications and median length of hospital stay were observed between groups.
Conclusions:
- Primary closure is associated with reduced need for ventilator support and PN.
- Surgical silo technique is a safe and effective alternative, yielding comparable digestive autonomy and length of stay.
- Both primary closure and surgical silo are viable options for gastroschisis management.
Aim Of The Study:
Optimal surgical treatment of patients with gastroschisis remains controversial. Recent studies suggest better outcomes with secondary closure techniques (surgical or preformed silo). The purpose of the study is to identify differences in outcome of infants treated with traditional primary closure (PC) versus surgical silo (SS).
Patients And Methods:
Retrospective study of patients primarily treated of gastroschisis between 2004 and 2014. Patients were divided in PC and SS according to abdominal wall closure. Non-parametric statistical analysis was used with p< 0.05 regarded as significant.
Results:
Twenty-seven patients were included (14M/13F). Primary closure was performed on 17 and 10 underwent surgical silo placement with a median of 6 (5-26) days till secondary closure. Prenatal diagnosis was available in most patients (74%) by the 20th week of gestation. There were no significant differences regarding sex, gestational age or birthweight between groups. Fewer ventilation days were required in PC group compared to SS (4 vs 13, p< 0,05), however, there was no difference in type of ventilation or oxygen needs. Sedation and parenteral nutrition requirements were also lower in PC patients 4 vs 10 and 12 vs 20 days respectively (p< 0,05). Post-operative complications (5vs6) and median length of stay (36vs43 days) were also similar in PC and SS patients. One patient ultimately died due to catheter-related sepsis. Mean length of stay in hospital was 42 days (20-195).
Conclusion:
Patients with gastroschisis who underwent primary closure showed shorter ventilator support and PN dependency than those treated with surgical silo. However, SS is as safe and effective technique as PC and led to similar outcome regarding digestive autonomy and hospital length of stay.
