Closing gastroschisis: The good, the bad, and the not-so ugly

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Congenital Abnormalities

Background:

• Closing gastroschisis involves bowel incarceration within a fascial ring, often with atresia.
• This condition has historically been associated with high morbidity and mortality rates.

Purpose of the Study:

• To develop and validate a new classification system for closing gastroschisis.
• To better characterize the spectrum of disease and associated outcomes.
• To improve long-term outcome prediction and patient counseling.

Main Methods:

• Retrospective case series of 53 infants with closing gastroschisis (2000-2016).
• Development of a novel classification system (Types A-D) based on bowel viability and atresia.
• IRB approval obtained prior to data collection.

Main Results:

• A new classification system (Types A-D) was developed, categorizing cases based on bowel status.
• Type A: Ischemic but viable bowel (15%). Type B: Intestinal atresia with viable external bowel (51%). Type C: Nonviable external bowel +/- atresia (26%). Type D: Completely closed defect (8%).
• Overall infant survival rate was 87%, exceeding previous reports. Long-term data provided for each type.

Conclusions:

• The new classification system accurately reflects the closing gastroschisis spectrum and aids in predicting long-term results.
• Early reduction and evaluation of external bowel are recommended unless clearly necrotic.
• Survival rates for closing gastroschisis are significantly better than previously understood.