Does staged closure have a worse prognosis in gastroschisis?

Schmidt, Augusto Frederico; Gonçalves, Anderson; Bustorff‐Silva, Joaquim Murray; Filho, Antônio Gonçalves Oliveira; Marba, Sérgio Tadeu Martins; Sbragia, Lourenço

doi:10.1590/s1807-59322011000400007

Cited by 9 publications

(11 citation statements)

References 32 publications

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“…Selection of the method of closure can clearly bias the conclusions of the study, which is highlighted in studies that compared primary closure to patients receiving a silo after failure of primary closure (Table 1) (15, 25, 28, 34, 35). Patients receiving a silo because primary closure has failed most likely represent a patient population prone to worse clinical outcomes (38).…”

Section: Discussionmentioning

confidence: 99%

Primary fascial closure versus staged closure with silo in patients with gastroschisis: A meta-analysis

Kunz

Tieder

Whitlock³

et al. 2013

Journal of Pediatric Surgery

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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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Section: Discussionmentioning

confidence: 99%

Primary fascial closure versus staged closure with silo in patients with gastroschisis: A meta-analysis

Kunz

Tieder

Whitlock³

et al. 2013

Journal of Pediatric Surgery

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“…Gastroschisis, rare congenital abdominal wall defect through which intra abdominal organs herniated, requires surgical management soon after birth. Although antenatal diagnosis and care have improved during the last thirty years; there were patients that were not diagnosed at antenatal period in our study (4).The mothers, not followed regularly in prenatal period, usually give birth at regional maternity hospitals where pediatric surgeons not working. On the other hand, infections during transfer were the cause of sepsis in externally-born infants (9).…”

Section: Discussionmentioning

confidence: 83%

“…The treatment strategies of gastroschisis vary with a wide spectrum from operative treatment such as primary closure, staged closure, with or without general anesthesia to nonoperative treatment (3)(4)(5)(6)(7)(8).Operative primary reduction, mostly depended to individual or selective cases, has become the standard initial surgical approach for more than 20 years, whereas operative staged reduction, mostly associated with poorer cosmetic outcomes, is frequently used as a protect strategy when reduction is deemed unsafe or physically impossible (3,4,7,8). Recently, obtaining a good cosmetic result for patient with gastroschisis has gained popularity as to put visceral organs safely into the abdominal cavity in the treatment.…”

Section: Discussionmentioning

confidence: 99%

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Gastroschisis Treatment: Evaluation of Surgical Techniques and Results

İnce¹,

Ezer²,

Temız³

et al. 2020

Bezmialem Science

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Amaç: Son zamanlarda, gastroşizisli hastalar için iyi bir kozmetik sonuç elde etmek, visseral organları karın boşluğuna güvenle yerleştirmek kadar popülerlik kazanmaktadır. Çalışmanın amacı, kozmetik sonuçlara odaklanarak hastaların sonuçlarını değerlendirmek ve literatürde kozmetik sonuçlara odaklanan sınırlı sayıdaki verilere katkıda bulunmaktır. Yöntemler: Ocak 2005'ten Mayıs 2018'e kadar gastroşizis nedeniyle opere edilen tüm hastaların tıbbi kayıtları geriye dönük olarak değerlendirildi. Bulgular: Gastroşizisi olan 22 hasta tedavi edildi (10 kız/12 erkek). Ortalama gebelik yaşı 38,2±2,1 hafta idi. Ortalama doğum ağırlığı 2256,9±418,2 g idi. Onbir hastaya doğum öncesi tanı kondu. Beş hastada komplike gastroşizis vardı; nekroz (n=3), perforasyon (n=4), volvulus (n=1) ve jejunal atrezi (n=1). Primer kapama (n=16) veya aşamalı kapama (n=6) yapıldı. Mekanik ventilasyon süresi ve total parenteral beslenme sırasıyla 3,7±1 gün ve 24,3±9,7 gündü. Enteral beslenmeye 15,9±10,5 günde başlandı. Hastanede kalış süresi 36,7±13,3gündü. Üç hasta sepsis ve multiorgan yetmezliği nedeniyle öldü. Sonuç: Hastaların doğduğu hastanede opere olmasının ve uygun cerrahi prosedür seçilmesinin başarı şansının ana faktörleri olduğunu düşünüyoruz. Bu çalışma da hastaların %86,3'ünde iyi kozmetik sonuçlar ve visseral fonksiyonlar elde edildi. Anahtar Sözcükler: Abdominal duvar defekti, gastroşizis, yenidoğan cerrahisi Objective: Recently, getting good cosmetic results for patients with gastroschisis gains popularity, as putting visceral organs safely into the abdominal cavity as. We aimed to evaluate the outcomes of the patients focusing on the cosmetic results to contribute to a limited number of data on this subject in the literature. Methods: From January 2005 to May 2018, patients operated for gastroschisis in a single institution were evaluated retrospectively. Results: Twenty-two patients with gastroschisis were treated (10girls/12boys). Mean gestational age was 38.2±2.1 weeks. Mean birth weight was 2256.9±418.2 g. Eleven patients were diagnosed by prenatally. Five patients had complex gastroschisis; necrosis (n=3), perforated (n=3), volvulus (n=1) and jejunal atresia (n=1). Primary closure (n=16) and staged closure (n=6) were performed. Patients needed mechanical ventilation and total parenteral nutrition for 3.7±1.0 days and 24.3±9.7 days, respectively. Enteral feeding was started at 15.9±10.5days. The duration of hospitalization was 36.7±13.3 days. Three patients were died from sepsis and multi-organ failure. Conclusion: We consider that appropriate surgery of gastroschisis at the same hospital without transferring another center is the main factor in the success. Good cosmetic results and visceral functions were able to achieve in this study in 86.3% patients.

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“…We in the postnatal period and secondary hypovolemia/ prerenal insuffi ciency to big insensitive loss caused by exteriorisation of the intestinal loops and a decrease in renal perfusion pressure caused by the sudden and inevitable rise in intra-abdominal pressure in the immediate postoperative period 17,18 .…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america

Redondo¹,

Feferbaum

Vieira

et al. 2016

J. Hum. Growth Dev.

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Introduction: Congenital malformations are major diseases observed at birth. They are the second most common cause of death in the neonatal population, the fi rst one being prematurity.Objective: To characterise the clinical outcome of newborns with gastroschisis (GS) in a neonatal intensive care unit. Methods:A retrospective observational clinical study in 50 infants with GS using the association of intestinal abnormalities, impossibility of primary closure of the abdominal defect and reoperation necessity as classifi cation criteria for the disease. The signifi cance level was p < 0.05. Results:The hospitalisation to primary surgery occurred with a median age of 2 hours. Fourteen percent of children were subjected to a primary silo interposition and 24% had associated intestinal malformation. Nineteen newborns (NB) required more than one surgery. The median length of stay was 33 days, higher in patients with complex GS (56 days). All NB recovered from urine output 48 hours after surgery and 40% had hyponatraemia and oligoanuria in this period. There was no difference between the natraemia and fasting time (p = 0.79). Weight gain was similar in both groups with total parenteral nutrition and became signifi cantly higher in patients with simple GS after enteral feeding (p = 0.0046). These NB evolved 2.4 times less cholestasis. Late-onset sepsis occurred in 58% of patients and was related to the infection of the central venous catheter in 37.9% of cases. Mortality was higher in infants infected with complex GS and the overall mortality rate was 14%. Conclusion:Clinical characterisation of newborns with gastroschisis depends on the complexity and the knowledge and conduct of morbidities to reduce mortality.Key words: gastroschisis, new-born, mortality, total parenteral nutrition, renal insuffi ciency, infection. INTRODUCTIONCongenital malformations are major diseases observed at birth. In the United States, a prevalence of about 3% 1 is cited. In Brazil, a study at the Fernandez Figueira Institute in Rio de Janeiro found that the prevalence was similar, i.e. 2.7% among live newborns (NB) and 6.7% among stillbirths. Among the causes of death, neonatal malformations are the second most common reason, the fi rst one being prematurity 2 .Gastroschisis (GS) is a congenital malformation of the abdominal wall that has increased in prevalence worldwide; its causes have not been fully elucidated 3 . In the 1960s, the prevalence of this disease was 1:50,000 live births. However, Kirby et al. 4 - -Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america J Hum Growth Dev. 2016; 26(2): 190-198 DOI: http://dx.doi.org/10.7322/jhgd.119266 temporal increase of 2.23 per 10,000 live births to 4.42 per 10,000 Regarding the defi nition of live births. The current prevalence in South America is 2.9:10,000 5 . This disease is characterised by a defect in abdominal wall closure with herniation of the intestines and other abdominal organs into the amniotic cavity. ...

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Does staged closure have a worse prognosis in gastroschisis?

Cited by 9 publications

References 32 publications

Primary fascial closure versus staged closure with silo in patients with gastroschisis: A meta-analysis

Primary fascial closure versus staged closure with silo in patients with gastroschisis: A meta-analysis

Gastroschisis Treatment: Evaluation of Surgical Techniques and Results

Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america

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