Surgical management of gastroschisis in North Queensland from 1988 to 2007

Abstract

Aim:To review outcomes of gastroschises originating in North Queensland and repaired in the neonatal centre in Townsville from [1988][1989][1990][1991][1992][1993][1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007], and compare these outcomes with published data from other centres. Methods: A retrospective chart review of outcomes after primary operative repair (POR) with wound closure in fascial layers in the theatre, primary non-operative repair (PNOR) with apposition of the umbilical cord and adhesive dressing in the ward, secondary repair (SR) after a silo, and complex repair (CR) of cases with obstruction, perforation or atresiae. Epidemiological data of babies originating in North Queensland but managed in Brisbane were secured from Mater Mothers' Hospital and the Royal Hospital for Children. Results: Fifty cases were treated in Townsville: 16 by PNOR, 22 by POR, 6 by SR and 6 by CR. Outcomes of uncomplicated cases treated by PNOR, POR and SR were similar. Outcomes of complicated cases after CR were significantly worse. No significant differences were found between PNOR in Townsvillle and published outcomes after SR from four overseas units. No differences were detected in outcomes of inborn and outborn babies, those delivered by vaginal or caesarean birth or between indigenous and non-indigenous babies. Three (6%) died. Gastroschisis is increasing in North Queensland, particularly in younger mothers. The incidence is 2-3 times higher in indigenous mothers. Conclusion: No significant differences were found between PNOR and other techniques for uncomplicated cases. PNOR avoids the use of theatre and staff, reducing delay and cost, and the need to transport a sick baby.

Outcome Differences Between Gastroschisis Repair Methods

“…In 2004, a sutureless technique for gastroschisis closure was reported [11]. The safety of this technique has been confirmed by many centers [12][13][14]. These reports, however, did not demonstrate any significant differences in patient survival, durations of hospitalization, parenteral nutrition support, and ventilator support.…”

Hospital readmission among infants with gastroschisis

“…4 After repair of the abdominal wall defect, infants with or without a complex lesion experience a period of bowel dysmotility, resulting in prolonged time on parenteral nutrition and subsequent prolonged hospitalizations lasting 4 to 8 weeks. 5,6 Changes in bowel function over time have not been formally evaluated among infants with gastroschisis, but persistent dysfunction could contribute to post-discharge morbidity and rehospitalization. Our objective was to identify the frequency of readmissions after initial hospital discharge among infants with gastroschisis and identify modifiable perinatal risk factors for readmission.…”

Improving gastroschisis outcomes: Does birth place matter?

“…They were, however, unable to find any statistically significant difference between groups [8]. Multiple single institution retrospective reviews with small patient numbers were subsequently published, all of which report contrasting outcomes related to inborn and outborn status [9][10][11][12][13]15]. Early enteral nutrition and primary closure resulted in improved outcomes in a few of these studies.…”

“…Recently, there has been a drive towards regionalization of care in neonates with complex congenital anomalies, such as gastroschisis [6,7]. However, the data to support a significant benefit to delivering gastroschisis neonates at institutions with immediate access to pediatric surgical providers and facilities are inconclusive [5,[8][9][10][11][12][13][14][15].…”