Avoiding High Pressure Abdominal Closure of Congenital Abdominal Wall Defects-One Step Further to Improve Outcomes
Raluca-Alina Mocanu1,2, Cătălin Cîrstoveanu3,4, Mihaela Bizubac3,4
1Doctoral School of "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Insights
Surgical repair of gastroschisis and omphalocele aims to close the abdomen without increasing intra-abdominal pressure. Monitoring this pressure can prevent abdominal compartment syndrome in neonates.
Area of Science:
- Pediatric Surgery
- Neonatal Intensive Care
- Abdominal Wall Defects
Background:
- Surgical repair of gastroschisis and omphalocele presents challenges in managing intra-abdominal pressure.
- Increased intra-abdominal pressure can lead to detrimental effects, including abdominal compartment syndrome.
Purpose of the Study:
- To evaluate the incidence of postoperative abdominal compartment syndrome in neonates undergoing surgical repair for gastroschisis and omphalocele.
- To assess the effectiveness of intra-abdominal pressure monitoring in preventing abdominal compartment syndrome.
Main Methods:
- Retrospective study of 47 patients with gastroschisis and omphalocele from January 2011 to June 2021.
- Analysis of postoperative abdominal compartment syndrome development in relation to primary versus staged closure.
- Implementation of trans-bladder measurement of intra-abdominal pressure.
Main Results:
- Six out of 47 patients (12.8%) developed clinical signs of abdominal compartment syndrome.
- Five cases were associated with primary abdominal closure, and one with staged closure using a polyvinyl chloride patch.
- No patients developed abdominal compartment syndrome after implementing trans-bladder pressure monitoring with a threshold of 10 mmHg.
Conclusions:
- Trans-bladder measurement of intra-abdominal pressure is a valuable tool in managing congenital abdominal wall defects.
- Maintaining intra-abdominal pressure below 10 mmHg during abdominal closure may prevent abdominal compartment syndrome.
- Further research and implementation of intra-abdominal pressure monitoring can improve outcomes for neonates with gastroschisis and omphalocele.
Abstract:
The main goal of surgical treatment for gastroschisis and omphalocele is the reduction of viscera in the abdominal cavity and closure of the abdomen, but the challenge is to succeed without the detrimental effects of increased intraabdominal pressure. In this regard, we performed a retrospective study for all patients admitted for gastroschisis and omphalocele to the Neonatal Intensive Care Unit of 'Marie Sklodowska Curie' Emergency Clinical Hospital for Children, from January 2011 until June 2021. Our aim was to highlight the presence of postoperative abdominal compartment syndrome. We observed that six out of forty-seven patients developed clinical signs of abdominal compartment syndrome, five associated with primary closure and one with staged closure with a polyvinyl chloride patch. Following the results, we decided to implement the trans-bladder measurement of intraabdominal pressure to avoid closing the abdomen at pressures higher than 10 mmHg in order to prevent the development of abdominal compartment syndrome. We consider that there is still place for the improvement of congenital abdominal wall defects management and that the measurement of intraabdominal pressure might help us reach our goal.
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