Don't Cut the Cord! Sutureless Repair of Gastroschisis-A Case Report

Gastroschisis is a congenital anomaly that results in the presentation of various portions of the bowel and abdominal contents outside of the body through a defect or opening in the abdominal wall. The absence of a protective membrane around the bowel is a hallmark sign of gastroschisis, in which prior to birth the bowel floats freely in the amniotic fluid. The anomaly is detectable via ultrasound, occurring early in embryologic development, but is not identified prior to 12 weeks' gestation, when the bowel fails to involute to the abdomen. Gastroschisis occurs in 4-4.5/10,000 live births in the United States. The greatest risks identified are maternal age <20 years, low body mass index, and primigravida. Classified as simple or complex, management of gastroschisis requires a multidisciplinary collaborative approach that includes obstetrics, maternal-fetal medicine, pediatric surgery, nutrition, and neonatology. Simple gastroschisis is closed with primary or staged reduction and closure, while complex gastroschisis requires surgical intervention to address associated complications, including bowel atresia, necrosis, perforation, or volvulus, leading to long-term management. This article presents a case report of a 37 3/7 weeks' gestation female who presented with simple gastroschisis managed with staged silo reduction and sutureless closure. This article reviews the embryology, epidemiology, pathophysiology, and classifications of gastroschisis, with a focus on sutureless closure involving the use of the preserved umbilical cord. Nursing management of surgical and postsurgical care and long-term concerns for the family are discussed.