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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.
Insights
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.
Abstract:
From 1972 to 1990, 69 cases of gastroschisis were treated at Akron Children's Hospital Medical Center. Eighty-one percent of these patients underwent primary closure of their abdominal wall defect. Thirteen of 69 patients (19%) required Silastic silos with final closure in an average of 7.8 days. There was no sex predilection, the average birth weight was 2,473 g, and the mean gestational age was 36.3 weeks. Twenty-six percent had associated anomalies, the majority were intestinal atresia, volvulus, and/or undescended testicles. Seventy-seven percent of the infants were delivered vaginally. Fourteen children were delivered via cesarean section. Seven cesarean sections were done solely for prenatal ultrasonic identification of an abdominal wall defect. There was no improvement in hospital stay, complications, days until enteral feeds were tolerated, days intubated, or number of surgical procedures in this group. In 14 patients, mesh sheeting (Marlex, Silastic) was used in the final closure. Sixty-four percent of these incurred wound breakdown necessitating removal of the mesh. This compares with a 3.2% wound breakdown in the nonmesh group. The average hospital stay was 43.9 days and the average time to enteral feeds 20.2 days. Sixty-four percent of the patients required postoperative intubation for an average of 5.5 days. The overall mortality rate was 4.3%. The present data do not support gastroschisis alone as an indication for cesarean section. The data indicate that mesh be avoided in the final closure if possible and support a favorable prognosis for most babies.