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Gastroschisis: an 18-year review
D A Novotny1, R L Klein, C R Boeckman
1Department of Surgery, Northeastern Ohio Universities College of Medicine, Akron.
Journal of Pediatric Surgery
|May 1, 1993
Summary
Gastroschisis treatment outcomes show primary closure is effective. Mesh use in abdominal wall defect closure increases complications, and cesarean section is not indicated for gastroschisis alone.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Gastroschisis is a congenital abdominal wall defect.
- Management strategies have evolved over time.
- Optimal surgical approaches require ongoing evaluation.
Purpose of the Study:
- To review treatment outcomes for gastroschisis.
- To evaluate the efficacy of primary closure versus silo placement.
- To assess the impact of mesh use and cesarean delivery on outcomes.
Main Methods:
- Retrospective review of 69 gastroschisis cases (1972-1990).
- Analysis of surgical techniques: primary closure, Silastic silos, and mesh sheeting.
- Comparison of outcomes including hospital stay, complications, and mortality.
Main Results:
- 81% underwent primary closure; 19% required Silastic silos.
- Mesh sheeting for abdominal wall defect closure led to 64% wound breakdown, versus 3.2% in the non-mesh group.
- Cesarean section, even for prenatal diagnosis, showed no improvement in outcomes.
Conclusions:
- Primary closure is a successful initial approach for gastroschisis.
- Mesh should be avoided in final abdominal wall defect closure due to high complication rates.
- Gastroschisis alone does not warrant cesarean delivery.