Gastroschisis closure—does method really matter?

• 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
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2007.12.030

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 (