Evaluating the risk of peri-umbilical hernia after sutured or sutureless gastroschisis closure

• Published in: Journal of pediatric surgery 2022-12, Vol.57 (12), p.786-791
• Main Authors: Fraser, James A., Deans, Katherine J., Fallat, Mary E., Helmrath, Michael, Kabre, Rashmi, Leys, Charles M., Markel, Troy A., Dillon, Patrick A., Downard, Cynthia, Wright, Tiffany N., Gadepalli, Samir K., Grabowski, Julia E., Hirschl, Ronald, Johnson, Kevin N., Kohler, Jonathan E., Landman, Matthew P., Mak, Grace Z., Minneci, Peter C., Rymeski, Beth, Sato, Thomas T., Slater, Bethany J., Peter, Shawn D. St, Fraser, Jason D.
• Format: Article
• Language: English
• Subjects: Congenital abdominal wall defect; Gastroschisis; Sutured closure; Sutureless closure
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.03.019

•Peri-umbilical hernia after successful gastroschisis closure is a consequence rather than complication, regardless of method.•Repair may be reasonably delayed, and safely observed, similar to umbilical hernias in the pediatric population.•Like pediatric umbilical hernias, spontaneous closure occurs with minimal complications. We evaluate the incidence, outcomes, and management of peri‑umbilical hernias after sutured or sutureless gastroschisis closure. A retrospective, longitudinal follow-up of neonates with gastroschisis who underwent closure at 11 children's hospitals from 2013 to 2016 was performed. Patient encounters were reviewed through 2019 to identify the presence of a peri‑umbilical hernia, time to spontaneous closure or repair, and associated complications. Of 397 patients, 375 had follow-up data. Sutured closure was performed in 305 (81.3%). A total of 310 (82.7%) infants had uncomplicated gastroschisis. Peri-umbilical hernia incidence after gastroschisis closure was 22.7% overall within a median follow-up of 2.5 years [IQR 1.3,3.9], and higher in those with uncomplicated gastroschisis who underwent primary vs. silo assisted closure (53.0% vs. 17.2%, p< 0.001). At follow-up, 50.0% of sutureless closures had a persistent hernia, while 16.4% of sutured closures had a postoperative hernia of the fascial defect (50.0% vs. 16.4%, p< 0.001). Spontaneous closure was observed in 38.8% of patients within a median of 17 months [9,26] and most frequently observed in those who underwent a sutureless primary closure (52.2%). Twenty-seven patients (31.8%) underwent operative repair within a median of 13 months [7,23.5]. Rate and interval of spontaneous closure or repair were similar between the sutured and sutureless closure groups, with no difference between those who underwent primary vs. silo assisted closure. Peri-umbilical hernias after sutured or sutureless gastroschisis closure may be safely observed similar to congenital umbilical hernias as spontaneous closure occurs, with minimal complications and no additional risk with either closure approach. Level II