Management of gastroschisis

Twenty consecutive cases of gastroschisis are presented. One patient died before surgery and 19 were managed with no surgical mortality. Both delayed closure with Silastic material and primary closure were used. The relationship of increased intra-abdominal pressure to the ease of abdominal wall closure is discussed and related to the prolonged gut dysfunction noted in this condition. The technique for both primary closure and silastic staging is presented. The technique selected for each case should be based on intragastric pressure measurements. Results suggest that either technique can be used with low mortality and that some of the morbidity and mortality reported for silastic closure is related to adaptation of a technique developed for closure of omphalocele to gastroschisis closure, without making allowances for the different pathophysiology of the two entities. Abdominal wall cellulitis seen following primary closure is discussed. The series studied suggests that the cellulitis is traumatic in origin and related to manual stretching of the abdominal wall.