These aggregate results suggest that primary operative therapy is associated with a lower in-hospital mortality rate, reintervention rate, length of stay, time with tube thoracostomy, and time of antibiotic therapy, compared with nonoperative treatment. The meta-analysis demonstrates a significantly reduced relative risk of failure among patients treated operatively.
Background/Purpose
Gastroschisis is the most common congenital abdominal wall defect.
Despite advances in the surgical closure of gastroschisis, consensus is
lacking as to which method results in the best patient outcomes. The purpose
of this meta-analysis was to compare short-term outcomes associated with
primary fascial closure and staged repair with a silo in patients with
gastroschisis.
Methods
We reviewed Medline citations, as well as the Cochrane Database of
Systematic Reviews, between January 1, 1996 and June 1, 2012. Articles were
identified using the search term “gastroschisis” and
[(“treatment outcome” or “prognosis”) or
randomized controlled trials]. Case reports, reviews, letters, abstracts
only, non-English abstracts, and studies that did not address at least one
of the outcomes of interest were excluded from the meta-analysis. Two
independent reviewers identified relevant articles for final inclusion. A
standard data collection form created by the authors was used to extract
study information, including study design, patient characteristics, and
reported patient outcomes. The data were analyzed using standard
meta-analytic techniques.
Results
Twenty studies were included in the meta-analysis. In the five
studies that selected closure method randomly or as a temporal shift in
practice, silo was associated with better outcomes, with a significant
reduction in ventilator days (p<0.0001), time to first feed
(p=0.04), and infection rates (p=0.03). When all studies were included,
primary closure was associated with improved outcomes.
Conclusions
Silo closure is associated with better clinical outcomes in the
studies with the least selection bias. Larger prospective studies are needed
to definitively determine the best closure technique.
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