Evolution of management of gastroschisis

Abstract

Background/purpose The management protocols and outcome of neonates with gastroschisis have improved significantly during the past two decades. The purpose of this study was to evaluate the evolution in management and outcome of gastroschisis in our institution. Materials and methods All patients treated for gastroschisis during the past 12 years were included. These patients were divided into two chronologically distinct groups. Group I included patients who were treated from 1998 to 2005 and group II included patients who were treated from 2005 to 2010. Each group was further subdivided into two subgroups according to the method of closure of the abdominal wall by either primary (group IA and group IIA) or delayed primary closure of the abdominal wall defect after temporary extra-abdominal hosting of the bowel using hand-sewn silastic or plastic sheets (group IB) or a spring-loaded silo (group IIB). Each patient was evaluated with regard to time spent on ventilator, time to initiating enteral feeds, time to discharge from the Neonatal Intensive Care Unit, and any complications. Results There was no difference between the two main groups with regard to the gestational age, sex, mode of delivery, or the percentage of associated congenital anomalies. Primary closure was feasible in 29 patients (18 in group IA and 11 in group IIA). Staged reduction of the herniated bowel and delayed repair were performed in 23 patients (12 in group IB and 11 in group IIB). Reduction of the herniated bowel and delayed staged reduction were performed earlier in group IIB than in group IB. Enteral feeding was earlier in patients who had primary closure either in group IA or group IIA compared with patients treated with delayed closure in either group IB or group IIB. Enteral feeding was relatively earlier in group IIB than in group IB, but the difference was not significant. Conclusion The overall morbidity and mortality showed significant improvement in the management of gastroschisis at our practice. The introduction of springloaded silo has simplified the management of patients born with gastroschisis who cannot be treated with primary reduction. Primary closure continued to have better outcome measures compared with staged closure.

Keywords: abdominal wall defect, complications, gastroschisis spring-loaded silo