Gastroschisis closure—does method really matter?

Abstract Background/Purpose Management of gastroschisis varies. This study aims to determine which aspects of practice influence outcomes. Methods All cases of simple gastroschisis (N = 99) in the Canadian Pediatric Surgery Network database were analyzed looking at methods of preoperative bowel prot...

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Bibliographic Details
Published in:Journal of pediatric surgery 2008-05, Vol.43 (5), p.874-878
Main Authors: Weinsheimer, Robert L, Yanchar, Natalie L, Bouchard, Sarah B, Kim, Peter K, Laberge, Jean-Martin, Skarsgard, Erik D, Lee, S.K, McMillan, Douglas, von Dadelszen, Peter
Format: Article
Language:English
Subjects:
Abdominal Wall - surgery
Closure method
Enteral Nutrition
Female
Gastroschisis
Gastroschisis - mortality
Gastroschisis - surgery
Gastroschisis - therapy
Gestational Age
Humans
Infant
Infant, Newborn
Maternal Age
Outcomes
Parenteral Nutrition
Pediatrics
Pregnancy
Spring-loaded silo
Surgery
Survival Rate
Suture Techniques
Treatment Outcome
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Summary:Abstract Background/Purpose Management of gastroschisis varies. This study aims to determine which aspects of practice influence outcomes. Methods All cases of simple gastroschisis (N = 99) in the Canadian Pediatric Surgery Network database were analyzed looking at methods of preoperative bowel protection, timing of closure, and closure techniques; and outcome measures included time to onset of enteral feeds, duration of parenteral nutrition (PN), and length of stay (LOS). Results One third of infants had initial bowel protection using a spring-loaded silo, which was significantly associated with a delay (beyond 24 hours) in establishing primary closure. Neither preoperative bowel protection methods nor defect closure techniques conferred any significant effects on success at establishing primary closure or functional outcomes. After adjusting for all covariates, only failure to establish primary closure was associated with impaired outcomes with significantly delayed initiation of enteral feeds and prolonged LOS. Low birth weight (
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2007.12.030