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Safety and usefulness of plastic closure in infants with gastroschisis: a systematic review and meta-analysis
Hiromu Miyake1,2, Shogo Seo1, Joshua S O'Connell1
1General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
Insights
Plastic closure may improve outcomes for infants with gastroschisis needing silo formation, reducing wound infections and hospital stays. However, evidence quality is low, necessitating further research on this gastroschisis treatment.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Abdominal Wall Defects
Background:
- Gastroschisis is a congenital defect requiring surgical closure.
- Closure timing includes primary or delayed methods after silo formation.
- The efficacy of plastic closure for gastroschisis remains under investigation.
Purpose of the Study:
- To evaluate the current evidence on plastic closure for gastroschisis.
- To compare outcomes of primary vs. delayed closure with plastic techniques.
- To assess the safety and usefulness of plastic closure in gastroschisis management.
Main Methods:
- Systematic review of studies on plastic closure in gastroschisis.
- Analysis of outcomes including mortality, wound infection, ventilation duration, feeding time, and length of hospital stay (LOS).
- GRADE approach used to assess the quality of evidence.
Main Results:
- No significant differences in mortality, feeding, or LOS for primary closure.
- Delayed closure with plastic repair showed significantly lower wound infection rates (OR 0.24).
- Plastic closure after silo significantly reduced ventilation duration, time to feeding, and LOS.
Conclusions:
- Plastic closure appears beneficial for gastroschisis requiring silo formation.
- Evidence supporting these benefits is of very low quality.
- Further high-quality studies are essential to confirm the utility of plastic closure in gastroschisis.
Purpose:
Recently, plastic closure of abdominal defect in infants with gastroschisis has been used. Timing of gastroschisis closure can be mainly divided into two groups: primary closure and delayed closure after silo forming. Safety and usefulness of plastic closure in gastroschisis remains unclear. We aimed to evaluate the current evidence for plastic closure in infants with gastroschisis.
Methods:
The analysis was done for primary closure as well as closure after silo. Outcomes were mortality, wound infection, duration of ventilation, time to feeding, and length of hospital stay (LOS). The quality of evidence was summarized using the GRADE approach.
Results:
In the "primary" group, there was no significant difference in mortality, time to feeding initiation and LOS. In the "silo" group, wound infection was significantly lower in plastic closure (Odds ratio 0.24, 95%CI 0.09-0.69, p = 0.008). Duration of ventilation, time to feeding initiation and LOS were significantly shorter after plastic closure (Ventilation; mean difference (MD) - 5.76, p = 0.03. Feeding initiation; MD - 9.42, p < 0.0001. LOS; MD - 14.06, p = 0.002). Quality of evidence was very low for all outcomes.
Conclusions:
Current results suggest that plastic closure may be beneficial for infants with gastroschisis requiring silo formation. However, this evidence is suboptimal and further studies are needed.
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