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[Gastroschisis. Management. 50 cases]
Insights
A multidisciplinary antenatal approach is crucial for improving outcomes in gastroschisis. Early diagnosis via ultrasound and planned surgical intervention significantly reduce mortality rates in affected newborns.
Area of Science:
- Pediatric Surgery
- Fetal Medicine
- Neonatal Care
Background:
- Gastroschisis is a congenital abdominal wall defect requiring surgical intervention.
- Historically, outcomes have been variable, necessitating improved management strategies.
Purpose of the Study:
- To highlight the importance of a multidisciplinary antenatal approach for gastroschisis.
- To evaluate the impact of diagnostic advancements and surgical timing on patient outcomes.
Main Methods:
- Retrospective analysis of 50 pediatric patients undergoing gastroschisis surgery (1975-1994).
- Outcomes assessed based on gastroschisis stage, surgical technique, and follow-up data.
- Evaluation of antenatal ultrasound diagnostic rates and timing.
Main Results:
- Antenatal ultrasound diagnosis improved significantly over the study period (16% to 92%), with detection at an average of 21 weeks gestation.
- Common intraoperative findings included perivisceritis (88%) and bowel atresia (10%).
- Postoperative mortality decreased from 46% to 15% over 20 years, correlating with improved management.
Conclusions:
- Antenatal ultrasound is effective in diagnosing gastroschisis and identifying risk factors.
- Planned delivery in a specialized Infantile Surgery Unit, informed by antenatal assessment, is recommended.
- A multidisciplinary approach is essential for optimizing outcomes in gastroschisis management.
Objective:
Demonstrate the need for a multidisciplinary antenatal approach to laparoschisis.
Material And Methods:
A retrospective series of 50 children who underwent surgery for laparoschisis between 1975 and 1994 in the Infant Surgery Department of the Strasbourg University Hospitals. Postoperative outcomes were evaluated as a function of the stage of laparoschisis and surgical technique. Follow-up was also examined.
Results:
Depending on the periods evaluated, ultrasound diagnosis varied from 16 to 92% and was made at 21 weeks gestation on the average. Lesions observed were atresia of the bowel (10%), complete intestinal involution (2%), and perivisceritis (88%). Complete parietal closure was achieved after bowel emptying in 58% of the newborns. Postoperative mortality, usually in vere severe forms, fell from 46% to 15% over the 20-years study period.
Conclusion:
Antenatal echography can confirm the diagnosis of laparoschisis. It can be used to define risk factors (size, bowel dilatation(s), mesenteric blood flow) allowing planned extraction in an Infantile Surgery Unit. This multidisciplinary attitude should help to improve overall outcome.