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

Abstract

Non-operative management of gastroschisis also known as plastic closure (PC) has been described as an alternative to conventional primary operative closure (POC) or staged silo closure (SSC). The aim of this study was to compare these techniques in neonates with gastroschisis. A retrospective review of neonates with gastroschisis who underwent PC was undertaken. The minimum follow-up was 1 year. Premature neonates (<35 weeks) and those with intestinal atresia or multiple congenital anomalies were excluded. Frequency matching of PC cases with two control groups with either POC or SSC was performed on 1:1 ratio, based on gestational age and birth weight. Statistical analysis using univariate analysis was performed. Three groups were assembled: PC, POC and SSC (n = 33). Median follow-up was 1,198 days. Groups were comparable with regard to: time to first feed, time to full enteral feeding, frequency of vascular access related infections, ventilation time, NICU LOS (length of stay) and hospital LOS. There was no difference observed in surgical complications. Almost all neonates in the PC group developed an umbilical hernia (83.8%). Umbilical hernias were highly associated with PC compared to the other two groups P = 0.001. To date only one patient has had to have an operative repair of the umbilical hernia in the PC group. Plastic closure is safe and comparable to conventional closure techniques. However, PC is associated with the development of more umbilical hernias. The natural history of these hernias remains to be defined.

Surgical management of gastroschisis in North Queensland from 1988 to 2007

“…Little difference, however, could be found between parameters of outcome after primary closure of uncomplicated cases in Townsville and secondary closure in other centres 4–7 suggesting no increased rate of compartment syndrome. Our findings accord with other recent studies comparing primary and secondary closure 9,10 …”

“…Our findings accord with other recent studies comparing primary and secondary closure. 9,10 Comparing POR and PNOR within our unit, no significant differences in outcome were found. The time to reach full feeds was greater after PNOR.…”

Outcomes of sutureless gastroschisis closure

“…In our series, there was no difference in the time to full enteral feeds with sutureless closure. Similarly, Bonnard et al [8] detected no difference in time to full feeds after sutureless and surgical closure. However, a recent survey of the Canadian Pediatric Surgery Network database suggested that sutureless closure might cause delay in oral feeding [4].…”

“…Sandler et al [1] originally described a case series of 10 patients. Bonnard et al performed a retrospective comparison of primary surgical, staged surgical, and sutureless closure of gastroschisis [8], comparing 11 patients in each study arm. This study showed no difference in any clinical outcome except for a higher incidence of small umbilical hernias after sutureless closure.…”

Congenital defects of abdominal wall

“…Синтетический протез также может быть применен для закрытия отверстия в апоневрозе [50]. Необходимо стремиться по возможности сохранить пупо-винный остаток для формирования в будущем пупка у ре-бенка [51,52]. Измерение внутрибрюшного давления пу-тем оценки давления в желудке или мочевом пузыре мо-жет помочь в выборе стратегии лечения [53].…”