Gastroschisis: ward reduction compared with traditional reduction under general anesthesia

Abstract

Background/PurposeIn gastroschisis it is proposed that gut reduction may be achieved without intubation or general anesthesia (GA) through ward reduction. The authors aimed to determine if ward reduction decreased morbidity and duration of treatment. Methods Infants born from January 1, 1995, to December 31, 2001, with gastroschisis were managed with either reduction under GA in the operating theatre (OT group)-up to September 1999, or ward reduction (when eligible) in the neonatal unit without GA/ventilation (ward reduction [WR] group)-from September 1999. Results Of the 37 infants, 31 were eligible for ward reduction-15 from the OT group, 16 from the WR group. All infants in the OT group had at least 1 episode of ventilation and 1 GA: 62% of infants in the WR group avoided ventilation (P = .0002) and 81% avoided GA (P < .0001). Infants who had ward reduction had significantly shorter durations of ventilation and oxygen therapy. Septicemia occurred in 31% of the WR group and 7% of the OT group (P = .17). Infants who had ward reduction left intensive care 16 days earlier (P = .02) and tended to reach full enteral feeds 8 days sooner (P = .06) and be discharged from hospital 15 days earlier (P = .05). ConclusionsInfants who had ward reduction do better in terms of avoiding GA/ventilation, establishing feeds, and going home earlier. A randomized, controlled trial comparing the 2 approaches is feasible, safe, and worthwhile.

Non-operative management of gastroschisis: a case-matched study

“…Average size of effect 208 (1.5-3.5) by fascial closure was associated with minimal time of mechanic ventilation, faster establishment of feeds and shorter length of stay [9,10]. The concept of PC, initially described by Sandler et al [1], is a technique, whereby a silo is initially placed; after complete reduction of the extruded viscera the fascia is left open and a dressing (usually utilizing the umbilical cord and a non-adherent dressing) is placed on the defect obviating the need for formal operative closure.…”

Early Primary Repair of Gastroschisis Without General Anaesthesia

“…8 Reduction of the abdominal content should be done within hours after birth, as delay in repair may cause water and heat loss from the exposed bowel, compromised gut circulation and infarction. 1 Reduction of gut can be done as primary reduction or as stage reduction. Operative primary reduction with closure of the abdominal defect continued to be the standard initial surgical strategy.…”

“…10 in 1998 published series of cot side reduction of 14 cases, out of them 12 were survived without anesthesia, used umbilical cord sutured to the rectus sheath to cover the defect and concluded minimal interventional management of gastroschisis is safe and applicable in our retrospective case control study and we could succeed in suturing the defect. Davies (2005). 2 in his retrospective comparative study between ward reduction and repair under GA of 31 infants suggested that in ward reduction group avoided ventilation in 62% of cases and avoided GA in 81% of cases.…”

“…1 Major controversies affecting the obstetrician, neonatologist and paediatric surgeon surround the management of gastroschisis. The surgical management of the abdominal wall defect has generated much discussion among paediatric surgeons.…”

Recent Advances in Neonatal Gastroenterology and Neonatal Nutrition

“…Primary reduction in the ward without the use of general anaesthesia practised this approach with reasonable success (Bianchi et al 2002, Davies et al 2005, Cauchi et al 2006 , whereas the others have found increased complications secondary to abdominal compartment syndrome , Dolgin et al 2000. The idea behind this approach is the potential for avoidance of general anaesthesia, avoidance of transfer to a surgical unit and facilitation of early enteral feeds because complete reduction has been achieved very early.…”