Sutureless closure for the management of gastroschisis
Modupeola Diyaolu1, Lauren S Wood1, Matias Bruzoni1
1Division of Pediatric Surgery, Lucile Packard Children's Hospital at Stanford University, Stanford, CA, USA.
Insights
Gastroschisis, a congenital defect with increasing incidence, involves exposed intestines in newborns. Management requires a multidisciplinary approach focusing on bowel protection and abdominal wall closure, with evolving bedside techniques.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Gastroschisis is a congenital anomaly where intestines are exposed outside the neonate's abdomen.
- The incidence of gastroschisis is rising globally, necessitating updated management strategies.
- Complicated gastroschisis, associated with other gastrointestinal issues, significantly increases patient mortality and morbidity.
Purpose of the Study:
- To discuss the presentation, diagnosis, and management of gastroschisis.
- To highlight the evolving medical and surgical approaches to gastroschisis.
- To emphasize the importance of a multidisciplinary approach in neonatal care for gastroschisis.
Main Methods:
- Review of current medical and surgical management protocols for gastroschisis.
- Discussion of diagnostic approaches for neonates with gastroschisis.
- Analysis of treatment strategies including temperature regulation, hydration, and bowel protection.
Main Results:
- Initial management prioritizes temperature regulation, hydration, and bowel protection in a neonatal intensive care unit.
- Surgical management involves bowel reduction and abdominal wall closure, with a shift towards sutureless techniques and silo placement.
- Bedside procedures are increasingly utilized, reducing the need for operating room and general anesthesia.
Conclusions:
- Gastroschisis requires a comprehensive, interdisciplinary approach involving neonatologists, surgeons, and respiratory therapists.
- Evolving surgical techniques, such as sutureless closure and silo use, have improved outcomes and shifted management to the bedside.
- Prompt diagnosis and appropriate management are crucial for improving outcomes in neonates with gastroschisis.
Abstract:
Gastroschisis is a common congenital anomaly in which the midgut fails to return to the abdominal cavity resulting in exposed intestines, which are not covered by a membrane in a neonate. The incidence of gastroschisis has been increasing worldwide resulting in an evolving medical and surgical management. Gastroschisis can be either simple or complicated. Complicated gastroschisis occurs when gastroschisis is associated with gastrointestinal conditions such as intestinal atresia, volvulus, stenosis or perforation. In this instance, the mortality and morbidity of patients significantly increases. Initial management of gastroschisis requires a multi-modal, interdisciplinary approach in order to successfully care for a neonate. Patients should be managed in a neonatal intensive care unit under the care of intensivists, respiratory therapists and pediatric surgeons. Temperature regulation, hydration and protection of the bowel are of the utmost priorities. Surgical management of gastroschisis focuses on reduction of the bowel and closure of the abdominal wall defect. Initially, the defect was closed primarily with suture, however, more recently, a sutureless closure has become prevalent. This, in conjunction with use of a silo, has led to a shift from the operating room and general anesthesia to the bedside. This article aims to discuss the presentation, diagnosis and management of gastroschisis.
